Each year during the early spring and summer months, hundreds of mares deliver healthy foals without incident, but for those mares and foals that have complications related to foal development or the foaling process, the time can easily turn into a nightmare for the caretaker and the mare and foal.

Most horse owners and breeders are aware of how important it is to have a veterinarian on-call for any emergencies that might arise during the foaling or shortly thereafter.

Foaling doesn't always have a happy ending

For caretakers of those mares and foals that develop complications, foaling time can turn into a nightmare and the horse owner needs to know when to call the veterinarian and have the number on speed dial.

Knowing when to call the veterinarian is an important part of being prepared for foaling and also enables the caretaker to remain calm and collected, which in turn helps both the mare and the new foal.

Studies by the US Department of Agriculture show that a little over 2% of foals die during the foaling process or within 2 days of birth. An additional 2.2+ percent die within thirty days of foaling.

Birth defects, infectious disease unrelated to a specific body system, blood infection (septicemia), prematurity, dystocia, injury/wounds/trauma, and failure to get colostrum or milk from the mare are reported known causes of foal deaths. In 2005, approximately 14 percent of foal deaths were from "other" causes than those mentioned and an additional 18 percent of foal deaths were attributed to unknown causes.

The sooner a foal with a blood infection or other serious illness gets to a facility where a blood culture and blood chemistry evaluation can be done and treatment can begin, the less the chance of dire consequences.

According to Jennifer Schleining, DVM, MS, Iowa State University College of Veterinary Medicine, "Most of the time, foaling is uncomplicated. It's those rare occasions that something goes wrong. Then you've got some pretty important decisions that you have to make readily. You may have to decide, if I had the option, do I want to save the mare or do I want to save the foal? Time is of the essence — you have a relatively small window to get the foal out properly to save the foal or the mare or both."

Dystocia, retained placenta and periparturient hemorrhage are the most common and potentially most life-threatening complications for the mare or the foal.

Other less common or less severe complications include uterine and rectal prolapse, perineal and rectovaginal lacerations, cervical and vaginal lacerations and uterine rupture..

Problems that affect the foal before and after delivery

As the placenta is invaded by bacteria, it pulls away from the uterine lining. This detachment causes less oxygen to be passed on to the foal, which retards the foal's growth and adversely affects its ability to survive.

The most common foaling abnormality is a dystocia, in which the foal is coming out in an abnormal position rather than feet and head first. For example, a leg or the head may be back or the foal may be coming out backward.

During the late stages of pregnancy, the umbilical cord, which normally has three clockwise turns, may become excessively twisted or wrapped around the limb of the fetus resulting in shutting off the blood flow in the cord. If complete, this lack of blood flow will result in the death of the fetus.

A foal delivered before the 320th day is considered to be premature. Foals delivered early are vulnerable to infection that may be passed on from the mare or contracted through outside sources. In addition, organs and bones may be under-developed, leading to respiratory and cardiac problems, along with soft, weak bones that cause problems for the foal when it attempts to stand.

Horse owner inspecting the newborn foal

Checking the new foal on a daily basis for any signs of ill health or problems with development is important to catch any developing infections or other health issues that might affect the foals ability to thrive.

Under-developed bones, especially those of the legs, will need to be evaluated by an orthopedic specialist. Soft bones will need to be put in casts or splinted so they develop in a straight, supported position. The foal may need to be sedated while this is being done.

If the foal cannot stand to nurse because of under-developed or crooked leg bones, care will need to be taken to make sure it receives colostrum or colostrum substitute during its first few hours.

If the foal has an infection in the navel, which sometimes happens, antibiotics may be used. Surgery to remove the infected navel structures may be necessary because the navel is a direct passageway to the bloodstream, allowing bacteria to spread to other areas, including the joints, with extremely serious consequences.

Problems that can affect the mare after delivery of the foal include the following:

1. Hemorrhage: internal bleeding caused by rupture of a large blood vessel will be evidenced by signs of severe pain in the abdomen followed by weakness, staggering, pale mucous membranes, shock and collapse. Usually there are no external signs of the bleeding. It is imperative that a veterinarian be called if any evidence of hemorrhage occurs.
2. Perineal and Vulvar Lacerations: The feet of the foal often tear through the mare's organs and membranes causing injuries to the vagina, vulva, and rectum. These injuries should be treated as soon as swelling and hemorrhage stop. Initially,careful cleansing of the wounds should be done.
3. Delayed Uterine Involution: Immediately following foaling, the uterus should begin to shrink and return to its normal size and shape. If your veterinarian finds that involution is not proceeding properly, oxytocin may be administered to stimulate uterine contractions.
4. Postpartum Metritis: This serious infection of the uterine wall, characterized by onset of toxemia, blood poisoning and laminitis is uncommon, but tends to occur after prolonged or complicated deliveries. A veterinarian will evacuate the uterus of infected blood and pus and administer intravenous oxytocin and antibiotics. Quick action is required to prevent a severe case of laminitis which can be severe enough to cause sloughing of the hooves.
5. Prolapsed Uterus: Prolonged straining during and after a difficult labor can cause the uterus to turn inside out and protrude from the vulva. The procedure to replace the uterus within the mare's body properly calls for an experienced veterinarian. Care must be taken to keep the prolapsed uterus from becoming contaminated or injured. Usually the mare is sedated for the procedure. Intravenous oxytocin and antibiotics are administered to prevent infection and shrink the uterus once it is back in place.
6. Nursing Problems: Some mares will have an insufficient milk supply and the foal will need to have supplemental feedings. If the foal nurses frequently and for long periods of time, it is likely it isn't getting enough milk. Mastitis is an inflammation of the mammary gland, and, although rare, it can occur a few weeks after foaling. The udder becomes warm, swollen and painful. The milk will appear curdled and usually contain blood. The foal will need to be hand fed and the mare's udder will need to be emptied by hand. Mastitis responds rapidly to treatment and the foal is usually able to begin nursing again within one week.

New foal checklist

Here is a list of post-foaling management practices that will help ensure the health of your foal and mare:

1. Make sure the foal is breathing
2. Put iodine solution on the foal's umbilical stump
3. Make sure the foal receives colostrum soon after birth
4. Make sure the foal is protected against tetanus either through the colostrum or a tetanus antitoxin injection if your vet recommends it
5. Make sure the foal passes meconium and treat constipation or diarrhea promptly
6. Check the umbilical stump for several days for presence of urine
7. Check that the foal's eyelids and lashes are turned outward
8. Follow your veterinarian's advice if any limb deformities or hernias are present
9. Make sure your mare expels the afterbirth and check it for completeness
10. Check the mare for several days after foaling for any signs of reproductive tract infections or injuries

Ideally, within 12 to 24 hours, the foal should have a veterinary examination and have blood drawn to determine that the foal has received the proper amount of antibodies into its bloodstream from suckling on colostrums.

If the foal has an inadequate amount of antibody, it needs to have a transfusion of plasma as soon as possible. This foal is at high risk for the potential of a blood infection that can be immediately life threatening. These infections can also result in joint infections and alter the athletic and even long-term life of the foal.

If at any time the foal acts depressed, seems to be laying down more, the mare’s udder enlarges or squirts milk on its own, this foal is a strong candidate for a blood infection and needs to be hospitalized where it can have a blood culture and blood chemistry evaluation immediately. It needs to be placed on proper fluid, nutrition, and antibiotic treatment as soon as possible.

The sooner a foal with a blood infection or other serious illness gets to a facility where a blood culture and blood chemistry evaluation can be done and treatment can begin, the less the chance of dire results. The foal needs to be placed on proper fluid, nutrition, and antibiotic treatment. Foals that have been down for 6 to 12 hours probably have a minimal chance of survival or, if they do survive, it will be at a costly medical effort.

Knowing when to call the veterinarian is extremely important and should be part of every horse owner's best management practices.

Although caring for a foal can be hard work, the joys of watching the physical growth along with the development of the "personality" of the growing foal can be very rewarding for the owner or caretaker.