10 emergencies to watch for in the hours after your mare foals

Phew! That baby is born. The past 11 months of waiting, monitoring, and hoping have ended, and that beautiful wet foal is now on the ground wondering what on earth just happened to her. Your mare, meanwhile, is back on her feet—curious and wondrous about that squirmy little ragamuffin that just came out of her.

It might be tempting to assume that all is well, and you can finally get your own much-needed deep sleep. Unfortunately, though, your bed will have to wait—you’ve only completed part of the complex process of successful foaling. The next few hours and days will be critical in determining the future physical and mental health of your mare and her newborn foal, says Christine Aurich, DVM, PhD, head of the Graf Lehndorff Institute for Equine Science, in Neustadt, Germany.

So get your foaling night blankets and hot thermoses of coffee—and brush up on your smartphone stopwatch features—as you keep a watchful eye out for these 10 red flags in the post-foaling period.

1. Foaling Passes the 20-Minute and/or 45-Minute Mark.

Careful breeders have their stopwatch apps open before they even see the foal, Aurich says. “At the moment the placenta breaks, and the birth process is starting, you should really start your watch,” she explains.

If the foal isn’t delivered within 20 minutes, there’s certainly a problem that merits investigation, she says. If handlers have had training in managing difficult births, they can try to help resolve basic problems like a stuck shoulder or flexed knee. Otherwise, they should call a veterinarian immediately.

Regardless, foals should be born within 45 minutes, Aurich cautions. Longer than that, and the foal is more likely to suffer from health issues such as general infections or neurological disorders due to lack of oxygen.

Good prenatal care can help prevent or at least forewarn handlers about issues that could complicate foaling, so they can be prepared, says Quinn Gavaga, DVM, of Charles Ranch Equine, in Ashcroft, British Columbia, Canada. “The health of the mare cannot be overstated,” he says.

2. The Placenta is Late—or Early—and/or Isn’t Y-Shaped.

Mares should deliver the placenta within three hours of birth, says Aurich. Otherwise, a retained placenta could cause uterine infection and the resorption of endotoxins, provoking sepsis (a whole-body reaction to bacterial infection) in the mare, which could also lead to laminitis. This “very dangerous and life-threatening” issue can usually be quickly averted with oxytocin infusions that make the uterus contract and expel the placenta.

But early placentas are red flags, too, she says. If the placenta and foal come out together, or if the placenta emerges before the umbilical cord is torn because the mare has gotten up, it was probably infected (evident as placentitis, or inflammation of the placenta). “An early placenta is always an alarm,” Aurich says. “It means there was a problem already before the foal was born and that the foal was most likely infected in the uterus.” These foals develop sepsis, requiring aggressive treatment.

Mares with placentitis could also have a red bag delivery. This condition occurs when the placenta separates prematurely from the uterine lining and—rather than normal translucent white or yellow membranes—you’ll see the bright red, velvety intact chorioallantois (the outermost layer of the placenta) at the vulvar lips. In these emergency cases the placenta must be opened immediately and the foal pulled out to halt asphyxiation.

After every foaling, handlers should lay the placenta out flat and ensure it’s complete, in its typical Y-shaped form, she adds. An incomplete placenta means a piece has remained inside the mare, which poses the same risks as retaining the entire placenta.

Handlers can also weigh the placenta while waiting for the veterinarian. It should weigh 10-12% of the foal’s weight; if the figure is less or more, it signifies a problem with the placenta.

Be sure to save the placenta in a plastic bag or bucket in a cool place for several hours because it could offer important clues if problems arise later, Aurich says.

3. The Foal Isn’t Standing Within One Hour.

Ideally, foals stand very quickly after birth—often within a matter of minutes, Aurich says. At the very latest, they should stand within an hour.

Some foals squirm and struggle to stand but just can’t succeed. Problems that could cause this range from contracted tendons and neonatal encephalopathy to sepsis.

Foals that don’t even try to stand within an hour are probably ill and need urgent veterinary care.

“When something goes wrong with foals, it usually happens pretty quickly—so don’t wait for it to get better on its own,” Gavaga warns. “It almost never does.”

4. The Colostrum Doesn’t Pass the Home Brix Test.

Before mares foal, owners should purchase a Brix refractometer, Aurich says. This instrument—designed primarily for the food and beverage industry—also serves as an excellent breeding farm tool to test for density or specific gravity of colostrum. (Colostrum with high immunoglobulin levels has a greater density and, thus, a higher specific gravity.) “It’s a very easy and really cheap way to check your colostrum quality right away,” she says.

Handlers should squeeze a small drop of colostrum from the mare’s udder—ideally, just after the foal is born—and place it on the refractometer prism. If the Brix value is at least 25%, that means the colostrum quality is good. If it’s above 30%, it’s very good. However, if the Brix value is below 25%—and especially if it’s lower than 20%—“then you know there aren’t enough antibodies for your foal,” Aurich says. “You have to call your vet to get frozen colostrum from a broodmare farm” or the foal will likely need an intravenous (IV) plasma transfusion.

5. The Foal Isn’t Nursing Within 2 Hours.

Among all the time-sensitive boxes to check, the intake of colostrum—the mare’s antibody-rich “first milk”—probably ranks No. 1 in importance, Gavaga says. Foals that fail to consume enough colostrum within the first few hours lack the antibodies that protect them from even the most common pathogens, he explains. That means they could easily fall sick, creating a domino effect of lingering health problems, including sepsis. Without rapid veterinary help, they’re likely to die within days. Sepsis is the leading cause of mortality in newborn foals, adds Aurich.

Healthy foals usually nurse within one hour of birth, but some can take a little longer before they start searching for the mare’s udder. If they’ve reached two hours without nursing, they absolutely need human intervention; call your veterinarian immediately.

After informing their veterinarians of the foal’s missed milestone, handlers should milk the mare themselves, Aurich says. This involves gently drawing on her teats and collecting the colostrum in a clean bottle designed for human babies. Handlers should be careful not to spill or waste the colostrum. It’s best to wait for veterinary assistance before offering it to the foal: Importantly, foals need to suckle and swallow on their own without being forced or having milk poured into their mouths, she adds.

6. The Foal Isn’t Getting Up to Nurse Every Half Hour, Suckles the Wrong Thing, or Gets ‘Milk Head.’

Foals usually lie down to rest after nursing. “But then they should get up after a short period, not longer than 30 minutes, and go again,” Aurich says. They should also act alert and interested. “That’s very important. If they’re not doing that, then something is happening. Something is wrong.”

The foal shouldn’t have milk on his neck, ears, or face, either, Aurich explains. “Milk-head” occurs when the foal approaches the udder but fails to latch on to the teat, and the mare’s body releases the milk in response to the foal’s contact, spraying milk onto the foal’s head. “It means the foal isn’t nursing correctly and isn’t getting enough nourishment,” she says.

Milk-head foals do not need “training” to nurse correctly, says Aurich. They need veterinary care. “You have to check the foal because it most certainly has a problem,” she says. It’s not that the foal doesn’t know how to nurse but, rather, she gets disinterested or too tired to drink once the milk is flowing. “In most cases, this is a sign that the foal is getting sick.”

But it might also be a sign the foal was born with a slightly premature endocrine system, Aurich adds. Before birth, foals usually produce progestogen, then shortly before the mare goes into labor, they switch to producing cortisol instead. In certain cases foals that appear fully mature might still be producing progestogen—which actually has a sedative effect, she explains. Therefore, they don’t adapt well to life outside the uterus, they might suckle incorrectly and get milk-head, or they might even try to suckle the mare’s legs or the barn wall.

Watching suckling behavior is the most reliable way to assess the health of newborn foals, because their body temperature and other vital signs are still naturally fluctuating, Aurich adds. “Taking temperature isn’t helpful,” she says. “But looking for normal behavior is.”

7. The Foal Is Retaining Meconium.

The foal’s digestive system needs to clear the dark, tarry contents it accumulated during gestation, known as meconium. Currently, the recommended practice is to administer one or two enemas at birth to avert meconium retention.

Foals that struggle to pass meconium tend to strain, lifting their tails and often standing as if they want to urinate, but to no avail. As time goes on, they can show signs of foal colic—acting restless and lying down as if they’re trying to keep pressure off the abdomen. In addition to the obvious welfare concerns, meconium constipation can cause foals to stop nursing—which prevents them from consuming the colostrum and nourishment they need to stay healthy.

Foals should poop approximately every half-hour for the first hours until all the meconium has passed, and yellowish milk feces appear. However, foals younger than 3 or 4 days old should never have diarrhea, Aurich adds. If they do, this is most likely septic diarrhea.

The first urine comes later. “If they are drinking—and drinking enough—they will certainly start urinating within 12 hours or so,” Aurich says. Colts typically urinate within eight to 10 hours, whereas fillies start within 12-14 hours.

Notably, owners should not assume an empty udder means the mare isn’t producing enough milk, Aurich adds. As long as the foal is nursing regularly, the udders always appear empty even though they might be producing abundant quantities of milk.

8. The Mare Seems Disinterested, Colicky, or Sick, or Has Bloody Manure or Urine.

Healthy mares show an interest in eating hay and pay close attention to their foals, Aurich says. They should be passing feces and urine within five or six hours of foaling.

Sick mares might act lethargic or depressed and could appear sweaty. Rectal temperatures above 38.5 C/101.5 For a resting heart rate higher than 50 beats per minute is cause for alarm. In a septic mare laminitis can start quickly, so handlers should check for signs of sore feet.

While mares might have mild abdominal discomfort for a few hours after foaling, they should not experience significant levels of pain, Aurich says. Importantly, pain should improve—not worsen—over time. Handlers should be concerned if the mare is getting up and down frequently, rolling and/or thrashing, or showing increasingly more severe facial expressions of pain such as tightening around the eyes, clenching the jaws, or pursing the lips. Blood in the urine or feces is another critical red flag.

Such signs could point to serious issues such as uterine prolapse, a retained placenta, damaged intestine, uterine rupture, or a burst artery with bleeding into the abdominal cavity. “These are real emergencies that have to be attended by a veterinarian,” she says. Haul the mare and foal to a clinic immediately if a vet cannot come right away.

“Better to transport her with hope of saving her, than just waiting at home until she’s dead,” Aurich adds.

9. The Foal’s IgG Levels and/or WBCs are Out of Range.

Veterinarians recommend testing every newborn foal’s blood in the first six to eight hours of life to check IgG concentrations.

An IgG reading under 8 grams per liter is a critical red flag showing the foal did not receive a sufficient transfer of antibodies. A white blood cell (WBC) reading outside the normal range of 5,500-12,000 cells suggests the beginning of sepsis.

Remember that 85% of antibodies from colostrum is transferred in those first eight hours. So, if you’ve tested within that window and the IgG is low, you still have time to feed colostrum (whether from the dam or a donor) nasogastrically and get adequate transfer; the foal’s intestinal tract cannot absorb these vital antibodies past 24 hours.

Beyond that eight-hour time frame veterinarians can provide the foal antibodies through IV plasma infusion.

As for other measurements, a particularly low or very high WBC count reveals an immune system reaction, our sources say. Practitioners can also run a serum amyloid A (SAA) test. The reading should be under 100-150 to verify the absence of bacterial activation of the acute-phase protein SAA, which is produced by the liver.

10. The Foal and Mare are More Interested in Anyone Besides Each Other.

Mare-foal bonding is critical for good physical and mental development of the foal as well as the welfare of both animals.

While handlers should not hesitate to care for their foals, especially when they need help, human interactions with foals should remain as minimal as realistically possible, Gavaga says. “Concentrate on the mare and make her feel as relaxed as you can,” he says. “Do what you need to help, but don’t try and force a bond with you and the foal. Respect the mare’s relationship with her foal.”

Red Flag? Do Not Wait.

If you see any of these red flags, contact your veterinarian immediately. “I don’t think people miss the signs that often,” Gavaga says, based on his own clinical experience. “I think owners wait too long to react.”

Post-foaling is certainly not the time for taking the wait-and-see approach, or to let nature work things out, Aurich adds. “Nature can be cruel,” she says. “Nature helping means the wolf or the lion comes for the weak foals that can’t get up and run away.”

For optimal post-foaling success, breeders should maintain a very good relationship with their veterinarians, Gavaga says. They will often then go above and beyond in supporting their clients in all the phases of horse breeding.

Take-Home Message

Mares and foals can appear healthy at foaling but quickly go downhill if they develop complications in the post-foaling period. Knowing the red flags and acting quickly can make a dramatic difference in the outcome of these scary situations, our sources say. “You can’t be prepared for every scenario,” Gavaga says. “But you can try to get as much knowledge as you can beforehand to be prepared for the main problems that can happen.”