Foaling Difficulties - the most important things
written by Jenni Phillips

We went to an excellent presentation in the Adelaide Hills (Springton) yesterday on Foaling Emergencies, with Dr Brad Newman from Florida in the USA. Brad is an equine reproduction specialist who is flown out from the USA every year to work at Cornerstone Stud (ex Lindsay Park Stud) from 1 Sept to 15 Dec (for foaling season). Thought I'd share the most important things I learnt:

1) Horses have one of the lowest % of "bad births" amongst domestic farm animals, at 4%. Cattle are much higher at around 12% and sheep higher again at around 16% - 18%. But when it does go wrong with horses, it tends to go very wrong very quickly. Horses have fast births because as prey animals, the universe wanted the mare lying down for the least amount of time possible, and then foal up and mare up and keeping up with the herd.

2) if the foal isn't out in 30 mins from the start of Stage II, (water breaks and she's having active contractions), then usually the foal won't survive. This is because in horses, the placenta starts to separate from the start of Stage II labour, and the foal will not receive enough oxygen after 30 mins to survive. So if you don't see the head and two front feet in a normal presentation, make the call to your vet really early and have a kit prepared with ropes etc if needed. If the foal slides out fine then it's not a wasted call. If the vet is further than 30 minutes away, YOU are going to have to do everything you can to get it out in the meantime.

Foals not receiving enough oxygen during birth is what leads to "dummy foals", as they have been oxygen deprived therefore have some level of brain damage.

Katherine's added feedback:

Can I just add to the 30 minute thing though.....Never Give Up. While the *likelihood* of a live foal will diminish the longer the delivery time, there is still a chance even after a couple of hours that the foal will be born alive, or revivable. And even if a foal is born dead, it is always worth a go trying to revive. Miracles do happen.

3) if the foal is displaced (ie not 2 front feet and a nose coming out) and you can see or feel feet, you / your vet if they can fix it in time (30 mins), has a chance to reposition the foal and get it out alive. If you cant see or feel feet in the birth canal (which is the whole of your arm up to the shoulder and sometimes still out of reach in a big horse), then it is highly unlikely the foal will survive as there is nothing to grab onto to pull.

** one of the most important things to have on hand if a foal has trouble passing through the vagina and gets stuck there is Lubricant. If you can lubricate this area, quite often the foal can slip out more easily.

If you work out you have the back legs coming out first (through feeling in there), keep going and help to get the foal out. You are never going to push back legs back in with the mare contracting against you, and the best thing to do is get it out so it can start breathing, as the placenta will be more detached already than if it is a normal "front feet first" birth.

4) if you have to do an extraction (ie pull the foal out), up to the strength of 2 men is ok to use. And it is very hard, physical work to re-position or extract a work (think whole of man strength and seeing stars through effort)

Katherine's feedback:
An analogy for the "two men's strength" thing...
Imagine you are moving furniture and need to get something through a doorway. You have your two strong men manhandling that item, but if it doesn't fit, adding more men to push harder is not going to solve the problem and may do damage in the process. All you need to do is change the angle, or reposition and the item will go through.

The pelvis is a rigid structure like the doorway...get the alignment right, and the strength of two men will be all you need. (sounds so easy doesn't it)

5) if you see a red mince looking bag before the foal, that means the placenta has detached and you have to get the foal out NOW as it will not have much oxygen left. This is the second most critical foaling episode of any.

6) Caesareans are usually aimed at recovering the foal and not the mare, as the chances of mare survival are very very low. Usually a c-section is done if the mare is not going to live and you're trying to save the foal only.

7) retained placenta is bad and you need to call the vet if it's not out within 3 hours because the retained tissue starts to die (necrose), and then releases toxins which are absorbed through the mare's blood stream and cause septicemia and foaling laminitis. Retained placenta does not impact future fertility.

8) if you've had to call a vet and you are unsuccessful yourself in repositioning the foal, if you can get the mare up and standing somewhere with her hindquarters elevated, that can help to slow down the contractions.

9) if the foal is deceased, the emphasis moves to saving the mare, and in these cases most times the way they do this is having to remove the foal but not in one piece (sorry to have to say that, but better to know and then forget than not know).

10) Prolapses. The more force that is used to extract the foal, the more likely it is that some internal organ will come with it. Sometimes the mare pushes so hard that her internal organs may follow. This could be her uterus, the bladder (that lies underneath the birth canal) or the rectum (which lies on top of the birth canal). The most important thing is keeping anything unusual that has come out clean and contained and not letting the mare step on it, until the vet gets there.

Uterine prolapses are usually fatal. Even if it gets put back in, there are lots of major blood vessels that are in and surrounding the uterus, and it is most likely even when the uterus is repositioned, a blood vessel will break and the mare will bleed to death.

Bladder prolapses are usually ok, even if they turn inside out. Rectal prolapses tend to have a good outcome as well.

11) If you have the terrible experience of losing a foal, make your best efforts to milk the mare to save the colostrum. Try for 250mls every 30 mins for the first 3 hours, and write on the side of the bag the IgG (if you have a spectrometer), the time, date and mare's name. One tragedy can help to save multiple of your future foals and the colostrum can be saved in the freezer for years to come.

Katherine's added comment:
Milking mares whose foals have died at birth....milk as much as you can. Depending on the mare, you might get anything from 100 - 400ml per milking. Give an hour or so between milkings, measure each collection's quality with a refractometer and record it, and keep collecting until the quality drops below ~25. Portion your collections into lots of 200-250ml for freezing (as you would never tube/feed a newborn foal more than that amount at a time). From an average sized mare, with average udder and average quality of colostrum, you should end up with around 1.5L of useable colostrum after milking out after a dead foal.

How much colostrum would you need in general to save an orphan foal's life?

For an average TB size foal, you would be wanting at least a litre of good quality colostrum.

12) the Very Most Important Thing is a clean and tidy paddock / stable that is free of manure / wire / falling down fencing / any form of sharp object / slush / mud / dam. Immunity is very low in new foals and birthing is a trauma to the mare, and clean and tidy surroundings make a bigger difference to foal and mare survival than anything else.

13) Foal meconium can be very dry and hard to pass as the foal hasn't had much to drink yet. If the foal is uncomfortably straining, use a Fleet enema in their anus to make it easier. Two if you absolutely have to if the meconium still hasn't passed in an hour. Not more, because the enema contains electrolytes and you can upset the foal's electrolyte balance.

14) Dr Newman suggested (and knew this would be controversial) that dipping navels in iodine is too harsh. If you have to use something, they use Chlorhexidine, but a clean foaling area is much more important than dipping in iodine.

15) Ideally, check the quality of the mare's colostrum 1 hour after birth with a spectrometer, and it should be in the range 25+. Any lower than that, call the vet.

16) Get the vet to check the IgG of the foal (on the spot blood test with the special test tubes) 12 hours after birth. 800 nanograms / decilitre is ideal. 600 is borderline ok. Anything less than that, discuss with your vet whether the foal requires plasma.

17) Miniatures have the highest % of foaling difficulties (I think he mentioned around 20% of births are difficult but I might be wrong on that). They are extremely tricky. Including a particular issue where foals are not strong enough to break the bag and tend to drown if foaling unattended. They are also the most common breed for bad foal presentation and position ie upside down, sideways, back coming first, twisted etc). If you have minis, you NEED to be there when they foal down.

18) Given that horses have the lowest incidence of difficulties, you have a 96% chance of everything going perfectly fine!! It is very important to be there during the foaling if you possibly can, and foaling alarms are a godsend when you are exhausted after being up and down for multiple nights on "foal watch".

Brad also showed us and talked through all the different positions and what to do and the success rates, but that definitely needs to be shown visibly, so for those who get the opportunity to go next time, it's Definitely Worth It.

Hopes this help others too.

Huge thanks to Georgia from FoalGuard Foaling Alarms for sponsoring the event and travelling all the way from Ballarat to be there and Katherine Szalay Evans for organising the presentation and making it happen."