Swift action was called for when champion American racehorse Rachel Alexandra developed life-threatening complications after foaling. Andrea Oakes finds out how both mare and foal were saved

Rachel Alexandra rocketed into the record books during a short but extraordinary track career. After storming to a 20-length victory in the Kentucky Oaks, she became the first filly in 85 years to win the Preakness Stakes — earning worldwide admiration and the title of America’s Horse of the Year 2009.

Yet last year the indomitable bay mare faced her toughest battle yet. During labour, Rachel suffered an intestinal injury that threatened her very survival — and that of her one-day-old filly. The story starts at Stonestreet Farm in Kentucky, after the uneventful delivery of Rachel’s second foal…

12 February 2013

Both Rachel and her foal, a bay filly by Bernardini, appear to be doing well. Stonestreet staff and vets from Rood & Riddle Equine Hospital observe the pair closely.

13 February 2013

Early in the afternoon, a change is noticed in Rachel’s demeanour. The mare has become unusually quiet and vets spot excess fluid pooling in her abdominal cavity — usually an indication of infection. She is rushed to the Rood & Riddle hospital for investigation and exploratory surgery.

The cause of the infection is found to be a devitalised (damaged) section of the small colon, which has lost its blood supply due to an injury while foaling. The rupture has released bacteria into the abdomen and caused secondary peritonitis, which can lead to inflammation, shock and death if untreated.

“In Rachel’s case, the location of the devitalised intestine was difficult to access,” says Dr Brett Woodie, who performed the “technically demanding” 6hr surgery.

“We removed this portion and connected the healthy ends of the intestine, before performing extensive abdominal lavage [flushing out] to remove inflammatory cells and bacteria.”

Fighting to recover, Rachel can no longer nurse her foal. The filly is hand-fed until she can be introduced to a nurse mare, a quarter horse called Miss Beutiful Ojos who is known as being sweet-natured with a good milk supply. The bonding process is carefully monitored.

Within 12hr of separation from her dam, Rachel’s filly is suckling happily from her surrogate mum. Miss Beutiful Ojos had stayed with her own foal until the filly had received the first colostrum. The youngster was then removed to be hand-reared with another foal.

14 February 2013

Rachel remains in a critical condition and continues to receive intravenous (IV) antibiotics, fluids and nutrition. She is also given anti-inflammatory agents, along with medication to counteract the effects of bacterial toxins and help prevent scar tissue in the abdominal cavity.

Several times a day, sterile fluids are infused through a fixed internal tube placed in Rachel’s abdomen before being allowed to drain and flush out bacteria, debris and inflammatory material.

It’s too early to give an accurate prognosis, but Dr Woodie reports that Rachel is doing “the best that can be expected”.

15 February 2013

While her condition remains serious but stable, signs are promising that Rachel’s surgery has been a success. She is brighter and more alert today.

“Rachel is a determined fighter,” says her owner Barbara Ranke, reporting that the mare has accepted a mint.

Back at Stonestreet, Rachel’s filly has adjusted well to her nurse mare and has been out in the paddock for the first time.

18 February 2013

Rachel receives a small amount of feed in addition to her IV fluids and nutrition. While she remains under close observation, she is well enough to go for a short walk outside for a bite of grass.

20 February 2013

The Rood & Riddle vets are pleased with Rachel’s progress, which has included several short walks a day.

Dr Woodie confirms that her gastro-intestinal function is returning, along with her “feisty” attitude. The course of postsurgery lavages is now complete and the drains in Rachel’s abdomen are removed.

23 February 2013

Rachel can now come off IV fluids and nutrition. She enjoys longer walks each day and grazes in-hand, under the watchful eye of medical technician Brent Comer.

7 March 2013

Vets detect an abscess adjacent to Rachel’s reproductive tract and rectum, which is confirmed by palpation and ultrasound. Rachel undergoes standing surgery to drain the abscess and quickly regains her appetite afterwards.

While this type of hurdle is not unexpected, it indicates that the mare still has some way to go before her recovery is complete.

26 March 2013

6 weeks after she almost died, Rachel can finally leave hospital and return to Stonestreet for the next stage of her recuperation. She will be monitored around the clock.

After a few days of gentle handgrazing, Rachel is transferred to a stall-sized pen that can be slowly extended as she grows stronger.

16 April 2013

Rachel is now enjoying 2hr turnout a day and continues to make good progress.

February 2014

A year later, Rachel and her filly are fit and well at Stonestreet. It is hoped that Rachel can breed again from next year. What is certain is that prompt and expert treatment prevented a double tragedy.

How rejected foals cope

Dealing with an orphaned or rejected foal requires plenty of expertise and patience, as Sarah Stoneham MRCVS explains

A newborn foal’s urgent need is colostrum, which should be ingested within 3hr of birth. The process by which the all-important immunoglobulins and other immune components pass directly into the foal’s bloodstream is very temporary — by 18-24hr, this route is closed.

The decision to separate a mare and foal should not be taken lightly, but is sometimes necessary if the mare dies or becomes seriously ill as in Rachel Alexandra’s case. Occasionally, milk production fails and cannot be resolved by medical treatment. Very rarely, a mare savages her foal and he must be removed for his own safety.

Emergency arrangements

If the foal’s natural mother cannot raise him herself, emergency arrangements must be made. In the meantime the young foal should be fed every 1-2hr with mare’s milk replacer, otherwise he will rapidly become hypoglycaemic and dehydrated.

The ideal solution is a nurse mare, who should be introduced very carefully to ensure the safety of the foal. It’s vital to have an adequate number of experienced people on hand for this familiarisation process and the new partnership should be under constant supervision for up to 48hr.

Selection of an appropriate nurse mare will depend upon temperament, her stage of lactation and the age of the foal. If she is in mid-lactation and a newborn foal is fostered on to her, it will be necessary to supplement the foal with the correct balance of minerals and trace elements.

Provided an appropriate foster mum is chosen, experience suggests that orphan foals reared on nurse mares do as well as their peers and have no behavioural problems. It is important to monitor the orphan’s weight and height as you would do with any foal to ensure correct growth. Nutritionists and stud vets can advise you about this.

Hand-rearing challenges

Unless the process takes place at a professional stud, I would strongly advise against bottle-feeding or bucket-rearing an orphan foal. Milk powder is expensive and a foal will drink up to 10-12 litres per day, depending upon size, for 3 months.

More worryingly, foals that are not reared with appropriate equine company from the start or not handled properly can develop severe and lifelong behavioural problems.

A nurse mare’s own foal will, of course, need rearing. When the offspring of “professional” nurse mares are hand-reared properly in groups and well socialised by expert handlers, however, there is every chance that they will grow up to become normal, healthy horses.

A technique for inducing lactation in mares that are barren but have previously had foals has recently been developed in Belgium. Mares of excellent temperament and mothering ability are prepared over 7-10 days before taking on a nurse mare role. I may have the opportunity to trial this technique this year — it could prove a useful solution in the case of orphaned foals.