Complications during the delivery of a foal are quite uncommon. That is a good thing, as the mare pushes during delivery with great force. If the foal is not positioned properly, the damage to the birth canal is often severe and in some cases, the foal dies. The mare will continue to push the foal to the outside, alongside the vagina if need be, or through the rectum and anus. It is therefore essential to take prompt action if the foal is not properly positioned.

Monitoring equipment
The actual birth of a foal does not take long: it is normally a matter of a mere ten minutes. Various types of monitoring equipment have been designed to ensure that one is in time for the delivery of the foal: camera’s in the stable with monitors in the bedroom of the owner and elsewhere. Some breeders go so far as to place a bed in the stable to ensure that they are present when the mare gives birth. Equipment is available that sounds an alarm if the mare lies down or begins to sweat. Or one may opt to place a sensor in the vagina of the mare that reacts to the presence of amniotic fluid that passes when the delivery begins.

Hands off
It is normally not necessary to pull on the legs of the foal during its delivery. The contractions of the mother are strong enough. That is to say, that applies to riding horses and other so-called warmbloods. It is a different story for so-called cold bloods, such as cart horses and Shetland ponies. Once the delivery begins, it is important to check that the foal is in a normal position. If so, you need not take any further action. Or as they say in Brabant, step back. There is only one reason for intervening, namely if you have established that the position of the foal deviates from normal. It is essential to act quickly and boldly if such is the case. But if you proceed to pull the front legs early during a normal delivery process, there is the risk of forcing the foal into a squatting position.

Rotating and stretching
Prior to the birth process getting underway, the foal is lying on its back in the uterus with its four legs folded up across its belly. Once the expulsion begins, the foal must rotate on its longitudinal axis so that it lies on its belly. In rotating, the foal first stretches its front legs. Once these, together with the head and neck, slide through the pelvis of the mare, the foal then stretches its rear legs as well. However, if the hooves of the bent rear legs wind up in the pelvis of the mare during the rotation of the foal, then this will result in a squatting position. A foal cannot clear the pelvis of the mare in that position: the long bones of the rear legs will then stand vertically at the entrance to the pelvis. No amount of pulling, however hard, will change this. The rear legs must stretch before the foal can safely pass through the birth canal. So if you pull the front legs of the foal before its rump has completely rotated and its rear legs have been stretched out in the uterus, you are at risk of pulling the hooves of the foal into the pelvis of the mare, which will obstruct further delivery.

Alarm
The horse pension accommodates around thirty horses and ponies. Mainly young girls come here to ride and clean up and have a nice chat. The upcoming birth of a foal rouses excitement in everyone. Watchful eyes take turns in the stable until late in the evening. When the mare finally shows signs that the delivery is about to commence, the human alarm system kicks into full speed: numerous telephone calls are made and within minutes, the stable fills up with people eager to see the outcome. By the time the mare is lying down and the amniotic sac appears in the birth canal, dozens of curious girls have gathered around the horse box.

Pulling
The stable owner takes the lead. He breaks the membranes, slides small ropes over the hooves of the foal and around its lower legs and starts to pull. The front legs and the head come out smoothly; the long neck is next and the foal is showing signs of life. But when the chest is halfway out, the delivery comes to a standstill. The mare is pushing hard and is glistening from the sweat, but the foal is not moving; it is stuck. Its nostrils open wide but it is not getting any air, as the foal’s ribs are jammed in the vagina. So it is impossible to breathe. Hurry, pull! The stable owner is pulling with all his might. But it does not help; the foal is stuck. He then sits down in the straw behind the mare with both feet pressed against the mare’s buttocks. Lying almost flat on his back, he again pulls with all his might: no result. “Pull, dammit!” screams one of the girls in a panic.
A father who has arrived to collect his daughter feels the atmosphere trembling with tension. He quickly takes over one of the ropes and begins to pull as well. But you cannot apply force when you are squatting down. So he too positions himself in the straw behind the mare and begins to pull like never before. Their heads turn red, their backs are wet with sweat. The mare is pushing madly, she is moaning and is banging her head wildly back and forth; beating against the wall of the box and the floor. Sweat is trickling from her body. The foal too is banging its head being its last death spasms.

a normal delivery of a foal does not require pulling

Silence
The men are exhausted and the foal is dead. Panting, they must admit that all of their pulling led to nothing. The foal is dangling in the straw behind the mare. Silence falls in the stable. Everyone is dismayed. The only sound is the panting of the two men. The girls retreat from the stable one by one. The mare is still pushing, but the force of the contractions is diminishing and the intervals are becoming longer. Her eyelids are swollen and damaged due to the banging with her head. Tears are welling in the eyes of the girl-owner. She stands alone with the horse at her feet, totally disheartened and at her wit’s end.

Delivery
I arrive at the stable with my delivery case twenty minutes later. The woman has meanwhile dried her tears and asks whether I can at least save the mare. It is too late to save the foal. The mare has stood up and is no longer pushing. The foal is dangling with its front legs on the mare’s heels. I quickly put on my work clothes. I locate the cause of all of the misery deep in the birth canal. The small rear hooves of the foal are beneath its belly on the edge of the mare’s pelvis. This made stretching its rear legs in the uterus impossible. Pushing the small hooves back into the uterus is not an easy task. Everything is stuck. But I manage and the birth of the foal is no longer a problem: I pull it out by myself. It hits the floor, immediately followed by the afterbirth. The mare is exhausted: she stumbles when she tries to take a step. The birth canal appears not to be damaged. I spread the afterbirth out on the ground: it is complete.

Crouch
Of all of the deviant presentations of foals at birth, the crouch is the most treacherous in my opinion. The delivery initially runs smoothly. Things do not stagnate until halfway through the birth process. Everyone’s natural reaction at that point is to help the mare by pulling on the front legs of the foal. Moreover, this deviant position is so rare that no one would suspect it: I had only one other case in my practice. That mare was found lying down in the stable with a half born dead foal. The monitoring system had failed and so the situation continued through the night. Only one of the small hooves of the foal was caught behind the edge of the pelvis. The deviant presentation had come about spontaneously. The repositioning and delivery went smoothly in that case as well, but the mare could no longer stand: the nerves in her pelvis had been constricted for too long. After three days of intensive care, including having the mare hoisted up twice a day by the fire department, the situation did not improve. That mare was then slaughtered.

How it ends
The mare at the riding stable was treated with an anti-inflammatory agent. It prevents the swelling of tissue and it also relieves pain. Nevertheless, the mare groaned as she urinated and defecated and her walk was staggered. She was carefully walked a few times a day and then given a cold shower under her tail: that whole area was swollen and warm. The mare made a complete recovery within a few weeks.
A package was delivered to the practice shortly afterwards. It contained a plaque with a horse’s head. It had a small plate at the bottom that read: “Thank you for saving my mare.”