How to deal with a difficult foaling [H&H VIP]

  • A tricky birth can quickly become a foaling emergency. Recognising a problem and knowing what to do next could be a lifesaver, as Sarah Stoneham MRCVS explains

    While most mares foal without trouble, it’s important to know what’s normal if you’ll be overseeing the birth.

    Equine parturition — the delivery of the foal — is usually a rapid process. Seemingly small abnormalities at this stage can have a significant impact on the outcome, threatening the health, or even life, of either the mare or the foal or both.

    A normal equine pregnancy lasts between 320 and 360 days, with an average length of 342 days (just over 11 months). The birthing process can then be divided into 3 stages:

    Stage one: this is the longest stage, usually lasting between 1-4hr. During this stage, the uterus starts to contract and the foal begins to turn and move into the birth canal. The mare becomes restless and frequently stops eating. She may repeatedly lie down and stand up. Mild “colic-like” signs may also include sweating and tail swishing. These early signs that the birth is imminent may be less noticeable in some mares, especially those that have previously had foals.

    Stage two: this begins with the rupture of the allantochorion (placenta) and the release of allantoic fluid as the mare “breaks water”. The second stage finishes with the delivery of the foal, which usually takes just 15-20min. Note that more than 30min is considered prolonged.

    Stage three: the process finishes with the delivery of the placenta, which usually takes place within an hour of foaling. Take note that more than 3hr is considered concerning.

    Foaling problems

    Complications can arise during or after the foaling. Common problems include:

    Dystocia: this is defined as a difficult birth that requires assistance.

    The most common problem is an abnormal presentation where the foal is in the incorrect position for a straightforward delivery. This is often associated with a deformity of the foal such as carpal contracture, a condition that prevents the foal from straightening its front legs.

    As time is of the essence, it is important to contact your vet at an early stage if things don’t appear to be progressing normally. You can then be given advice over the phone about what to do before the vet arrives.

    If the vet is unable to correct the problem promptly, emergency admission to a clinic may follow — either for a controlled delivery under general anaesthesia or a caesarean section.

    Red bag: another name for premature placental separation, a red bag delivery occurs when the placenta fails to rupture over the foal’s feet as they pass through the birth canal. A red, velvety sac then appears through the vulval lips.

    This is a real emergency that requires prompt action to save the foal. Call your vet immediately and describe the problem, so you can be talked through the process of rupturing the placenta manually. You will then need to deliver the foal and help it to breathe before the vet arrives, because if the placenta is not ruptured the foal will be unable to breathe.

    Stillbirth: a normal foal will start “gasping respiration” immediately on delivery, and the amniotic sac should be cleared from its muzzle without delay. It should be struggling to sit up on its sternum within 5min.

    Sometimes, the foal is not breathing at all when it is born — a problem that can occur following an apparently normal foaling.

    If the foal is able to be revived, it will need to be resuscitated immediately if it is to stand any chance of survival. This means being on hand with the necessary knowledge and, ideally, a foal resuscitator.

    It’s worth downloading the free app at www.veterinaryadvances. com/apps/foal-cp. It clearly illustrates foal resuscitation, but do ask your vet beforehand how to use the apparatus. If the foal can be revived, call your vet without delay for further health checks.

    Post-foaling haemorrhage: this potentially life-threatening condition can occur in the hours after foaling.

    The mare will be bleeding from one of the large internal arteries that supply blood to the uterus. Initially, the haemorrhage will be contained within the ligaments around the uterus. If the bleeding continues, however, and ruptures the ligaments, the mare is likely to haemorrhage into the abdominal cavity, with fatal consequences.

    If haemorrhage has occurred, the mare may show colicky signs such as sweating and shaking, and her mucous membranes will rapidly become pale. Keep her as quiet and comfortable as possible until your vet arrives.

    The condition is more common in older mares, although it can occur at any age. Other problems, such as post-foaling colic can occur, so keep a close watch.

    When to intervene

    Once the mare goes down for foaling, using some clean, disposable gloves and obstetric lubricant to feel gently inside her vagina. You should be able to feel two front feet with a muzzle lying between and slightly above them, closest to the mare’s spine.

    If all feels correct, observe quietly from a distance to make sure that stage 2 of the labour process progresses normally. If it doesn’t, or if the mare fails to deliver the foal within 20min from her waters breaking, call your vet without delay.

    Preparation for foaling

    Ideally, the mare should be moved to the foaling box 2-4 weeks before her expected foaling date. If you are sending her away to foal, she should go 3-4 weeks before her due date so that she can develop immunity to the local pathogens. She will pass these antibodies on to her foal via the first milk, or colostrum.

    The foaling box should be well lit and measure at least 3.6×4.2m. Make sure that it is thoroughly cleaned and disinfected before allowing it to dry and laying down a deep, clean straw bed.

    You will need easy access to power points and hot water. It’s also important to be able to observe the mare without disturbing her — a CCTV system is ideal. There are several types of foaling alarm available, but they vary in reliability and in the stage at which they will alert you.

    Keep turning the mare out until she is due, as gentle exercise is important to maintain muscle tone and circulation. It is also worth considering where you intend to turn her out with her young foal. A small, securely fenced and clean paddock with a good surface or grass cover is ideal.

    In warmer, drier climates, some stud farms foal mares outside in special individual paddocks, which can be lit and where the mare can be observed throughout the night. In the UK, it is generally considered better to foal in a stable or barn due to our unpredictable weather.

    Foaling facts

    More than 1,000 births were assessed in a recent study published by Colorado State University, which involved breeds including thoroughbreds and American quarter horses.

    The following facts emerged:

    ➤ Colts had an average gestation of 344 days and fillies 340 days.

    ➤ More than half foaled between 8pm and 2am.

    ➤ Roughly 10% had a difficult foaling — 13.8% in thoroughbreds and 7.9% in quarter horses.

    ➤ Stage 2 labour lasted less than 20min in three-quarters of cases.

    ➤ A stage 2 labour lasting more than 40 minutes significantly increases the risk of foal mortality

    ➤ In cases of dystocia, 38% involved postural problems such as the legs or head back. A third involved a normal presentation where the mare had weak uterine contractions or the foal was very large. 16% of the foals had failed to turn and were presented upside down.

    ➤ Less than 2% of normal length pregnancies resulted in a stillborn foal — but the risk increased with prolonged pregnancy or premature birth.

    Useful kit

    Putting together a basic foaling kit prior to the birth is a good idea, but make sure that you are familiar with any equipment beforehand and have been shown how to use it by a suitably qualified person. Useful items include:

    Obstetric lubricant

    Disposable gloves

    Clean tail bandage

    Scissors: for opening the mare if her vulva has been stitched in a Caslick procedure (when the vulva is stitched to prevent infection)

    Foal resuscitator

    Oxygen cylinder and tubing for using the cylinder

    Refractometer: for checking quality of colostrum

    Spray: for treatment of umbilical stump