Emergency C-sections in horses *H&H VIP*

When showjumping mare Billy was struggling to give birth to a vastly oversized foal, there was no time to lose. Her owner Russell Stevenson and the referring vet Mike Barrott, from Cinder Hill Equine Clinic, loaded her up immediately for a journey to the Sussex Equine Hospital.

Hospital stud vet Dr Noelle Baxter explains that dystocia, the term for difficulty giving birth, is a true emergency.

“The potential for life-threatening complications for both mare and foal is very high,” she says. “Placental separation occurs within an hour of the onset of stage two labour. The foal then starts to lose oxygen, having relied on the placenta for oxygen transfer from the mother’s bloodstream.”

On arriving at the hospital, Billy then underwent an internal examination.

“It was clear she had a very large foal in a tilted presentation,” says Noelle. “We could not delay progression towards surgery, but I kept trying to deliver the foal as Billy was being prepared for anaesthesia. Once the mare is anaesthetised, her hindlimbs are elevated. This can allow the vet enough space in the birth canal to rearrange the foal into a position that enables manual delivery, but not in Billy’s case. The baby was just too big.”

Quick work

Within minutes of Billy arriving in the operating theatre, surgeon Luis Rubio Martinez had made the first incision.

“The sheer size of the foal meant that it was quite a job to manipulate him to a position where we could help Luis pull him out of the uterus,” says Noelle. “As Luis completed surgery, the resuscitation team set about managing this high-risk foal.

“His airway was cleared and we held him in a position to help drain excess fluid from his lungs,” she adds. “We administered oxygen and attended to his umbilicus while monitoring his vital signs, but he had started breathing on his own immediately after he was delivered.”

The foal, nicknamed Billy Bub, was transferred to a warmed bed and dried with towels, which helped to stimulate his circulation. Before long, he was trying to right himself onto his chest in the sternal recumbency position.

“There was some evidence of neonatal maladjustment syndrome, also known as hypoxic ischaemic encephalopathy or ‘dummy foal’,” says Noelle, explaining that the condition is a common complication after delivery of a live foal by Caesarean section. “Oxygen deprivation can damage the foal’s brain and cause incoordination, depression, convulsions and death. The condition may have a quick onset or develop 12-24 hours following birth, so it is important to monitor the foal for an extended period after delivery.”

Once Billy Bub displayed a strong suck reflex, he could be fed colostrum, the mare’s antibody-rich first milk. Soon after, his dam had recovered sufficiently from anaesthesia to meet her foal in the intensive care unit.

“Billy’s beautiful temperament and motherly instincts were key to successful bonding after such a traumatic and unnatural birth,” says Noelle. “Over the next 24-48 hours, the foal improved in demeanour and strength and was introduced into his dam’s stable. It was a big moment for the team to see Billy Bub get up and suckle on his own.

“After a few days, mare and foal were ready to go home — with Billy Bub already standing 130cm tall [nearly 13hh] and weighing a healthy 80kg.”

Ref Horse & Hound; 24 January 2019