A Practical Guide to the Foaling Process

G. Marvin Beeman, DVM
(originally printed in The Western Horseman)

NOTE: This article appeared in The Western Horseman in February '76 and '83, and again, by popular demand, in March '92. It was brought to our attention by a staff member as the most helpful foaling article she, an experienced equestrienne, had ever read. We agreed and are pleased to reprint the article with the permission of The Western Horseman.

The author, Dr. G. Marvin Beeman, Littleton, Colorado, is one of the nation's most renowned veterinarians. He received the Distinguished Service Award from the American Association of Equine Practitioners at their 1991 convention.

The foaling season is eagerly awaited by all breeders - whether they own just one mare or a hundred. After almost a year of waiting, watching, and anticipating, it's a time to rejoice when the brand-new foal arrives, and all is well with both mare and foal.

Steps to ensure a healthy foal begin soon after the mare becomes pregnant. She should have proper nutrition, be up-to-date on her immunizations, teeth care, and parasite control, and have moderate exercise, especially if she is confined to a stall or small pen.

FIGURE 1: Thanks to research done by Dr. Leo B. Jeffcott, we now know that the foal stays on his back until labor begins. In fact, the back legs and rump remain upside down even as the front legs, head, and neck twist to move up and over the pelvic bone shelf as foaling begins. In a normal foaling, the frong feet appear first, with the soles of the feet down, or slightly sideways. The nose follows the feet.

A common question asked by many owners of pregnant mares is. "How long after she is bred should hard work be stopped?" It is my opinion that as long as a mare is accustomed to strenuous work (racing, trail riding, jumping, etc.), she can continue to do so through the fifth month of pregnancy. Radical changes in her exercise pattern should be avoided. For example, she should not be fatigued, etc. After the fifth month, strenuous exercise should be reduced, but continuation of some moderate exercise is very important.

As foaling approaches, many mares have a tendency to exercise very little, and a significant number of these mares will develop ventral edema. This is a large swelling that extends from the udder along the ventral abdomen, and sometimes forward to the front legs. Such a mare will benefit greatly from exercise even if she has to be forced to walk (longing, hot walker, etc.).

The gestation period for a mare ranges from 320 to 365 days, with 340 days accepted as the average. During the first part of her pregnancy, she should be properly fed, but not allowed to become obese. Many people mistakenly assume they should begin "feeding for two" as soon as a mare becomes pregnant, but it's not until the last 90 days that her requirements for protein and energy increase considerably. However, she should still not be allowed to become obese. Overly fat mares sometimes have trouble foaling.

As the mare's foaling time approaches, a routine for her care should be developed and not altered. This means that a safe stall, paddock, etc., of her own should be prepared well in advance to the due date so that she can become accustomed to them and to her feeding and care routine.
For example, several days before she foals, begin leaving a light on in her stall at night. Then you won't have to turn on the light when you check on her. . . for if you do and she is in the process of foaling, it might startle her and stop the foaling process.

Make sure she has a safe place to foal. It's foolish to spend the money for a good broodmare and a stud fee, and take care of the mare for 11 months, and then not be concerned where she foals. Remove all water tanks or barrels, and anything else that might prove harmful to a new foal struggling to his feet. We've seen newborn foals that drowned after falling into tanks.

Check the fencing if the mare has access to a pasture or paddock. It should be safe fencing, and close to the ground. We've seen mares foal so close to a fence that the foal got up on the wrong side; that can result in all kinds of trouble.

Keep the mare by herself. Geldings will sometimes stomp a foal to death, and jealous mares sometimes try to steal a new baby away from his mother.

Whether a mare should foal in pasture or in a stall depends on the facilities available, weather, and personal preference of the owner. There is certainly nothing wrong with foaling in a clean pasture. But no matter where she foals, I feel someone should be present to help her if an emergency arises.

With the approach of parturition, several changes will be noticed in the mare's appearance. First of these signs is a general relaxation of the muscles and ligaments of the pelvis (more specifically, the sacrasciatic ligaments). This will be most noticeable on each side of the tail head. This process begins 3 to 4 weeks before foaling, but the marked relaxation and looseness around the anus and vulva do not occur until 24 to 48 hours before foaling. At this same time, the vulva swells and the vulvar opening increases two to three times in size. Udder development begins several weeks (3 to 6) prior to foaling and gradually enlarges. During this period there is often a small straw-colored, semi-hard droplet on the end of each teat. This is not to be confused with "waxing".

Waxing most often occurs 24 to 48 hours before foaling, and is that process in which a variable-sized, horn-colored waxy substance forms at the end of each teat. The waxy substance remains for 12 to 24 hours, then softens and falls away in a viscous stringy form. Then milk (colostrum) begins to drip from the teats.

When all of these signs are evident, foaling usually occurs in a matter of hours, perhaps 12 to 24.

All of a mare's foaling signs should be recorded for future reference since she is likely to follow the same general pattern year after year. Then any radical change of pattern is a signal of impending trouble.

Some owners use transmitters of various kinds to help alert them to impending labor in a mare. While technology is great, it usually should only be used as a back-up to personal observation. On some large breeding farms, a combination of transmitters and night watchmen is used. Even so, mares are notorious for fooling everybody and foaling only when they are good and ready.

The actual foaling process is best described in three phases: 1/ the preparatory phase, 2/ actual labor, and 3/ expulsion of the fetal membranes.

The first stage is not characterized by straining or labor; instead the mare will show signs of restlessness and may stand alone and gaze off, and have an unfriendly attitude toward other mares. A little later she may exhibit slight nervousness or signs of discomfort. She will extend her tail slightly and frequently pass small amounts of feces and urine. She will paw the ground, look at her side, or kick gently at her abdomen. Actually these signs are quite like that of mild colic and are often difficult to differentiate. She will sporadically stop fidgeting and take a bite of feed. She will often sweat over the neck, flanks, and occasionally over the entire body. This first stage may last 1 to 4 hours.

When these signs appear, there are certain basic things that should be done for the mare. First, her vulva, the surrounding area, and the udder should be cleaned up. Use a mild disinfectant or Ivory soap. The latter is very good because it is non-irritating, has a good cleansing effect, and you can still use a little disinfectant if you wish.

By all means, if her vulva was sutured after her previous foaling or when she was bred, it should be reopened. Actually, this should be done about 1 month before she foals, so if she surprises you and foals early, she won't tear.

Her tail should be wrapped. The tail is contaminated, and it's going to be in the way even if it's clean. So wrap it to keep it out of the way.

The first stage that we have talked about will last 1 to 4 hours. It is not an all-day procedure. The mare should not start showing these signs extensively, then quit. If she does, you should consult your veterinarian, as she might be in trouble. Sometimes when a mare has a foal that is positioned backward (a breech birth with the tail coming first), she will go into the first stage of foaling, and the water bag might even rupture; then progress will slow down or stop. She definitely needs help at this time.
The second stage takes place when the water bag ruptures. It consists of a large amount of fluid. After it breaks, the foal should arrive within the next 5 to 45 minutes.

This is the time when you, the owner, should 1/ know your mare, and 2/ be prepared, because it will be in these next minutes that you might be able to prevent a disaster if trouble arises. You should have on hand a bucket with clean water and a little disinfectant in it, Ivory soap, some paper towels, iodine, glycerin, and a small glass. Your hands and arms should be clean-washed with soap and veterinary disinfectant just in case you need to help. And your fingernails should be cut short.

Fortunately, foaling mares don't have problems very often, but when they do, they're most often very serious. Most mares get a little apprehensive about foaling; and if they do get in trouble, it's hard to help them because of their strength and temperament. Cows aren't that way. A cow can have a calf stuck with a leg twisted back, and she'll wander around all day with the calf in that position . . . giving the veterinarian time to get to her and help her.

But this will rarely, if ever, happen with the mare. She decides that time's up, and she's going to have that foal even if it means tearing herself up. We've seen mares that have forced the foal's feet right up through the rectum, tearing the whole thing out. When this happens, the foal most often dies, and the mare obviously has very serious consequences.
The one consoling fact is that mares do not have trouble very often. But you should be alert, and you should be ready to help her just a little bit if necessary.

Watching a mare foal requires some physical restraint on your part because it is an exciting event for most horse owners. You started this whole program 11 months ago; you have a lot of money invested in the mare and foal; and you probably have a lot of sentimental feeling for the mare and great expectations for the foal. So it's awfully hard to stand there quietly and watch instead of running in and lending a hand. You have to know when to help, and when not to help, this depends on whether the mare is having a normal foaling.

The Foaling Process
In a normal foaling, right after the water bag breaks, you should see another sac coming with a front foot in it, with the other front foot just behind it.

We now know that a foal stays on its back until the actual foaling process begins. Then, during labor, the foal's body twists in such a way that the forelegs and head turn over as the foal advances up and out of the mare's body (Figure 1). The back legs and rump usually stay in and upside-down position until the foal is actually being delivered. This helps the foal to maneuver up and over the pelvic bone shelf.

When delivery starts, the soles of the forefeet will be down. The feet will be followed by the nose, which will be just above and in front of the knees. If you see this, as shown in Figure 1, everything is fine.

Once the foal starts coming, the mare will have three to five strong expulsive efforts, followed by 2 to 3 minutes of rest. Then she will repeat these efforts. Particular effort is required for the foal's shoulders and hips to clear. After that, the back legs emerge, and you've got a brand-new foal. Normally, all of this should not take more than 45 minutes after the water bag breaks.

Sometimes the mare will "hang up" and the foaling process stops after the foal's front legs appear. If things don't start up again within 5 minutes, and if you are a little concerned, you won't hurt her if you decide to check on things. Wash your hands and arms, then reach inside the mare's vulva and see if the foal is in the position shown in Figure 1.
If the foal is positioned okay, but he isn't making much progress, grasp those front legs. When the mare strains, pull the legs slightly upward and out, with one leg slightly ahead of the other. Be sure to relax the pull when the mare relaxes. You first pull up and out because the foal must first slide up and over the rim of the mare's pelvis. When the elbows and shoulders clear, the direction of the pull should be down, toward the mare's hocks — following the normal curvature of the foal's body.
Remember, don't get excited and pull when the mare is not trying. As soon as she strains, pull just a little. Then try to hold some of the slack you have gained until she strains again; then you pull again.

If it's a great big foal and starts to hip-lock (get hung up at his hips when he's halfway out), pull him right down between the mare's hind legs. But be careful a mare can kick just as hard lying down as she can standing up. She's not apt to kick, but she might.

If you need to help pull a foal, you do all that you need to do with your hands. Do not use the car, tractor, a jack, or any other mechanical force. Sometimes it is necessary to take drastic measures, but they should only be done by people trained to do them.

Once the foal is out, or almost out, and you know everything is okay, check his head and nostrils If the sac hasn't broken, break it. If there is mucus in his nostrils, wipe it out so he can take a good, deep breath. If he's doing a lot of gurgling and not breathing correctly, lift his head, as this will allow considerable mucus to drain from his nostrils. If that doesn't work, get someone stout to help you hold him up by the back legs and let that mucus drain. Do not do this unless necessary. But if you have to lift him, try not to break the umbilical cord.

If the little guy is breathing okay, he and his mother should be allowed to lie quietly, even though his back legs might not be all the way out yet. If the navel cord is still attached, leave it alone! The foal will receive a considerable amount of blood from the placenta through this navel cord. If you do something to cause the mare to jump and break the cord, the foal could actually have a blood deficit, which can cause serious problems.

Even when the foal perks up and starts getting active, don't worry about the navel cord. And please, do not break it, cut it, or tie a string around it. More than 90 percent of the time, the navel cord will break naturally when and where it is supposed to break.

As the minutes tick by, you will notice a constriction starting to take place in the navel cord a short distance from the foal's abdomen. This is where Nature has provided for it to break. Only in rare cases, when it is obvious that injury might result if the cord doesn't break, should it be manually separated. To do this, put one hand on each side of the constriction and pull it apart. It will break right where the constriction is. Do not pull with just one hand because you could actually eviscerate the foal. Pull between your hands. Or, use a sharp knife to cut the cord at the constriction.
It is even more rare for a navel cord to need tying off. After the cord breaks, the remaining fluid and blood in the cord should be allowed to drain out. Clamping or tying off the cord traps bacteria in it and creates the worst kind of infection that a foal can get.

If you happen to have the rare foal whose cord starts to hemorrhage profusely with bright red blood, take some strong twine or cord (either sterile or iodine-soaked) and tie it off as close to the body as possible. Notice that I said bright red blood. The blood that normally drains from the cord is not circulating in the body and therefore is blackish in color. If it is bright red, it means that it is coming from the foal's circulating blood, and it should not be allowed to continue.

After the cord breaks, the next important step is for the navel stump to be treated with an efficient disinfectant. A good one is a mixture of glycerin and 7 percent tincture of iodine; mix them in equal parts. Do not take cotton and just daub it on. Instead, put the solution in a small container, such as a 1-ounce shot glass, and soak the stump area for 30 seconds. This will prevent the entrance of bacteria found in the straw, grass, dirt, or wherever the foal was born.

The foal came from a relatively sterile environment, but his surroundings now are not sterile, and that's why he's very susceptible to infection. Therefore, soaking the umbilical stump is very important and should be done as soon as it breaks not an hour later or the next morning.

Foaling Problems
Now let's take a look at some of the problems that can be encountered in foaling. As I said earlier, mares fortunately have little trouble in foaling; but when they do have a problem, it most often is very serious and help should be summoned immediately.

FIGURE 2: Trouble! The foal positioned backward will drown if not pulled out as quickly as possible. Your first clue that something is wrong is the soles of the feet, which are up.
Also as mentioned earlier, the actual foaling should take place within 5 to 45 minutes after the water bag breaks. The first thing you normally see after that is the sac coming with the front feet. But if instead you see something red and velvety-looking (premature placental separation), it is the afterbirth coming before the foal, and you need your veterinarian. The foal must also be delivered quickly if this happens because its blood supply is compromised.

Anytime you need help, or you don't feel capable of handling the situation, the foaling should be delayed. This can be done by getting the mare on her feet and making her walk. Often this will delay the foaling until your veterinarian can get there.

If it is a normal foaling, the front feet will appear first, with the soles of the hoofs down, or slightly to the side. If the soles are up, it means one of two things: 1/ the foal is coming backwards, or 2/ they are the front feet of a foal still in the process of turning over.

FIGURE 3: When the head is twisted back, the layman can sometimes correct it, but it's a difficult job. If you can't, get the mare up and walk her until the veterinarian arrives.
To find out, break the sac and run your hand up the leg to see if it is a front leg or back leg. . . by determining if the next joint above the ankle is a knee or hock. You can tell this by the way it bends in relation to the fetlock. Think, because you can get excited and make a mistake. Also make sure that there are two of the same kind of legs; you don't want a front leg and a back leg, and that can happen.

If the foal is still upside down, get the mare up and then let her lie down again. Many times this will correct the situation. Your twisting the legs while the mare is getting up and down will often help correct the situation, too. The foal will turn over, and out he will come.

A foal that is coming backward (Figure 2) is a serious problem, and this foal needs help right away — by you, because you do not have time to get your veterinarian. The backward foal needs to come out immediately, and here's why.

As the foal starts out over the brim of the pelvis, pressure is put on the umbilical cord. This shuts down the oxygenated blood supply to the foal. As a result, carbon dioxide builds up in his brain, and this is what makes him start breathing. When the foal is coming headfirst, this is fine; but if he is backward, his head is still down in the fluid and he might drown if he starts breathing before his head is clear of the uterus.

FIGURE 4: When the head is tucked between the front legs, no part of the foal will appear after the mare progresses into labor. You need your veterinarian immediately, and he might have to perform a Caesarean section, or take other measures.

When you have a foal coming backward, first make certain that he is right sideup. If not, correct this quickly. Then pull him as fast as you can. Pull more than just when the mare strains. . . just pull him out as fast as you can, and you might save his life. You have a 50-50 chance.

Another problem: the foal whose head is twisted back (Figure 3). If the normal foaling process stops after the front feet emerge, examine the foal as described before. If you cannot feel the nose, the head is twisted around. Once in a great while you can push back on his chest with one hand, and reach around and grasp him in the area of the eyes with your other hand and straighten the head and neck into a normal position.
Most of the time, however, this is a monumental task. If possible, it should be corrected before the mare gets into heavy labor. If you can't correct it quickly, get her up and walk her until you can get professional help.

There are several malpositions that will prevent any part of the foal from being presented after labor has progressed. One example: when the foal's head is tucked under his body, between the front legs (Figure 4). You can tell this because in your examination you will feel the mane or poll. Some of the most difficult foalings I have seen have been this kind. I might try to get the head up one time; if I couldn't, this case is a good candidate for an immediate Caesarean section, or similar measures.

A breech birth (Figure 5) is another example when no part of the foal will appear. You can determine this because the tail will be the first thing you feel in your examination. This is another monumental problem. You either have to sacrifice the foal and cut his legs off, or do a Caesarean.

FIGURE 5: The breech birth is another example when no part of the foal will appear after the mare goes into labor. The veterinarian will have to do a Caesarean, or sacrifice the foal and cut his legs off.

There are other abnormal positions for foaling, but these are the most common. What you should remember is the correct position in a normal foaling. If there is any deviation from this, you should get help as quickly as possible. The two exceptions to this rule are the backward foal, and the separation of the placenta; then, get the foal out as quickly as you can.
Here are several hints to remember if the foal isn't breathing after he comes out of the sac. By twisting an ear a little, or pinching his anus, or inserting a piece of straw into a nostril, making him cough, you can often make him start breathing.

If these procedures fail to make him breathe, artificial resuscitation must be administered. Be certain the fluid is cleared from the upper respiratory tract. Extend the foal's head and neck to assure an open airway, close his mouth, and cover one nostril with your hand. Place your mouth firmly over the other nostril and blow. You must blow hard enough to expand the foal's chest. The procedure should be repeated every 2 seconds until the foal begins to breathe on his own.

If everything is okay, leave the mare and foal alone, giving them time to get acquainted. The nuzzling and licking that the mare often does is a stimulus to the foal to begin trying to get up, and it also stimulates the sucking reflex.

When the foal tries to get up, he's going to stumble and fall around, but leave him alone. He's not going to hurt himself. Just be sure to remove the water bucket, and any other hazards. I've seen more foals get into trouble by being exhausted from people trying to help them than I have with foals left alone.

Don't worry about the mare stepping on the foal, either. Rarely does this happen. If a newborn foal develops lameness, most often it is the result of infection in a joint, and not from being stepped on by his mother.

Before the foal starts to nurse, step into the stall quietly and wash the mare's udder with a little warm water and Ivory soap. The udder can be a source of infection because stalls are a good source of bacteria.

The foal will normally nurse in about 30 minutes; if he goes up to 2 hours without nursing, it still isn't a serious problem. But after 2 hours, the mare and foal should be examined to see if a defect (either in the mare or foal) is preventing him from nursing. For example, the mare could have a mammary abnormality such as short nipples, or the foal could have a cleft palate.

If the foal has not nursed at the end of 2 hours, an attempt should be made to get some milk into him. It should be his mother's milk, and he should be assisted enough to start him nursing on his own. There are various ways to assist him, but space does not allow describing them. Most important: Do not exhaust the foal in trying to help him nurse.

If he still hasn't nursed after 3 hours, it might be better to milk the mare and give it to the foal via a bottle; or your veterinarian might give it via a stomach tube (only a veterinarian should do any tubing).

It's very important that the foal's first milk be colostrum, preferably that of his mother. The colostrum provides antibodies that are the foal's first line of defense against infection. Not receiving the colostrum can severely limit his ability to resist infection in his early life. Giving the foal something else to drink, like cow's milk, will immediately change his ability to absorb the anti-bodies when he does nurse, so that should not be done.

If a mare has dripped milk for 2 or 3 weeks before she foals, she has probably lost her colostrum. If this happens you have a couple of options. One is to obtain colostrum from a colostrum bank maintained by some breeding farms and veterinary clinics and have it ready for your foal's first meal. (Let the colostrum thaw at room temperature; zapping it in the oven or microwave will destroy its antibodies.)

The other option: Use one of the commercial replacement products now available, which must be given intravenously by a veterinarian. Your veterinarian can also do a blood test to make sure the foal received enough colostrum.

Another thing to watch for is a bowel movement by the foal. Sometimes it's difficult to tell if he's had one because the feces are minute and will disappear into the bedding. If you don't actually see him have one, don't worry about it unless he starts straining to have one. Then he should have an enema.

You can make an enema solution of water and glycerin (do not use soap; it is extremely irritating) and apply with an enema can and rubber tube. Or, you can buy a commercial enema product from your veterinarian, or one of those made for human babies and sold at pharmacies and supermarkets.

To give an enema, raise his tail and insert the tube just a few inches into the rectum, and infuse 4 to 6 ounces of solution. Then push his tail down so he doesn't excrete it for a few minutes. After that he should start passing extremely hard fecal balls called meconium. The process may have to be repeated, and occasionally manual assistance might be necessary to relieve the impact mass.

These fecal balls can really impact a foal, and I've seen foals strain so hard they bled from the navel stump. That should never be allowed to happen.
The third and final stage of foaling is the expulsion of the afterbirth, which consists of the membranes that were attached to the uterus. Most of the time, a mare will "clean" (shed the afterbirth) within 30 minutes. If she hasn't done so within 3 hours, call your veterinarian. The majority of mares will actually be okay up to 8 hours, but your veterinarian needs to plan his schedule so he can get there by the eighth hour and treat the mare. Otherwise, if she retains the membranes longer than 8 hours and receives no medication, she could develop complications foundering being one of them.

When the mare starts to pass the membranes, tie them up so they are in a ball. This will prevent her from tearing them and/or injuring herself by stepping on them, or catching them on some object. Do not pull on those membranes! If you do, you might telescope a uterine horn. If this happens and you pull on it, out comes the uterus and a mare's uterus bleeds like you've never seen anything bleed. The mare can bleed to death in a very short time. So just tie the membranes up in a ball and let their own weight create the tension necessary to assist expulsion.

When the mare has completely cleaned, the afterbirth should be saved for your veterinarian. He will examine the membranes to make sure a piece was not torn off and retained in the mare. When this happens, it can create a very serious problem and even result in the mare dying. The condition of those membranes also indicates any presence of disease, infection, or edema, which will help determine if the mare should be bred back on her foal heat.

As a matter of interest, the expelled membranes (afterbirth) will look very much like a pair of pajama bottoms with the feet in them.

We now have the foal on the ground and nursing, and the mare has cleaned. There are problems that can yet develop so watch both mare and foal closely, and call your veterinarian if necessary.

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