What can go wrong
Several foaling complication sequelae might arise. 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.
Photo 1: Obstetric chains applied to a foal in a breech presentation. Note the mare is still standing before extensive contractions
"I think that there's definitely a difference between the most common complications that you see and the most life-threatening
things that you see," Wolfsdorf says. "You might be presented with a mare that has a dystocia that ends up with postpartum
metritis or a deeper infection in its uterus that can have a vulvar discharge, which needs to be treated. This can be successfully
treated with uterine lavage, intrauterine and systemic antibiotics, anti-inflammatory medications and oxytocin."
Most of the problems are those that affect the mare. "Obviously, if we can get a live foal, that's what we want. But we also
want to be able to send home a reproductively normal mare so she can continue to produce foals," Sheerin says.
"The first stage of parturition is the one that the mares themselves can manipulate, and they can put off labor until it's
the middle of the night when nobody is watching," says Schleining.
Stage two starts when the water breaks. "After you've seen the water break, you should have a foal on the ground within 30
minutes," Schleining states. "That doesn't give you a whole lot of time to get in and intervene and still have a live foal.
If you don't have any progress by 30 minutes, you need to figure out why."
Photo 2: The mare is now in lateral recumbency as contractions become more powerful. Assistants continue to apply tension
on the obstetric chains with a veterinarian helping position the foal in the birthing canal.
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. (See Photos 1 through 4,
to better understand a breech position delivery.)
Most of the time, as long as you can get the foal repositioned, the situation will be resolved. Most veterinarians are pretty
adept at doing this at the farm. If the mare is given an epidural, similar to the procedure in people, then the foal is much
easier to reposition, and it can be assisted out. "But if it is a very large foal or the mare continues to strain and you're
trying to reposition the foal, you can end up with ruptures of the uterus or other complications," Schleining says.
Photo 3: The foal is now halfway out. The umbilical cord can be seen in the veterinarian's left hand.
To save the foal if it is coming out backward, speed of delivery is important, Schleining says. Air supply is critical. If
the foal doesn't breathe within five minutes of expulsion of its chest, or if it is delivered backward and it doesn't breathe
within minutes, permanent brain damage or death will occur. Similarly, if the fetal membranes remain on the foal's nose after
its chest has been expelled, they should be taken off so it can breathe.
Photo 4: One final push before the foal is completely out. The rib cage is just now visible.
"With the dystocia," says Sheerin, "if you're working with it on the farm, you have a limited amount of time for your manipulations
before you decide to refer it or, if referral is not an option, to do something more aggressive." Dystocia that cannot be
corrected on the farm and requires referral can have a more serious prognosis. The outcomes of the mare and fetus are often
tied to the length of time of dystocia prior to resolution.
"In central Kentucky, we have the luxury of sending everything into the clinic, so the majority of dystocias are sent to the
clinic if we can't get them resolved at the farm," Sheerin notes. "Once at the hospital, we'll anesthetize the mares, raise
their hind ends, and then do the manipulations that are necessary. In most cases, we can have a controlled vaginal delivery,
and then everything is fine." If a practitioner is faced with a difficult case on the farm and the client is a great distance
from a referral center, it's best to send them early.