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Observation
What you see. The starting point for addressing any equine health related issue is your observation.

YOU ARE OBSERVING

Foaling, Prolonged Labor, 2nd Stage Labor Lasting Over 20 Minutes

Summary

SUMMARY
Your mare is foaling, but it seems like the process is taking longer than it should. ***Stage 2 labor (active pushing after the water breaks) that has gone longer than 20 minutes without a foal on the ground is a true emergency for both foal and mare. Every minute matters.

Foaling in the mare is explosive. Once strong abdominal contractions start and the water breaks (rupture of the outer fetal membrane), the foal should be delivered within about 20 minutes, and almost always within 30. If delivery is delayed, the foal is in danger. Once the placenta begins to separate from the uterus during stage 2, the foal's oxygen supply is being cut off while the foal is still inside the mare. A foal that is not delivered promptly will die or suffer brain damage from lack of oxygen. The mare is also at risk of serious injury and complications. Prompt and correct action is critical.

  • Code Red

    Call Your Vet Immediately, Even Outside Business Hours
    • If you have any doubt about the length of time your mare is taking to deliver.
    • Questions coming up around foaling should usually be discussed right away with your vet.

your role

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What To Do

Call your vet immediately when you know the mare is foaling (you should have done this prior to put them on alert) and describe the situation. In some cases, they may be able to reach your location rapidly. If this is not possible, they will likely be able to lead you through assisting your mare over the phone, step by step. I personally have helped quite a few times this way. Keep your phone with you, on speaker, and keep the line open.
TIME GUIDELINES - WATCH THE CLOCK
• Stage 1 (restless, sweating, up and down, looking at flanks, lifting tail): usually 30 minutes to 4 hours. Length varies and is not usually the concern.
• Stage 2 begins the moment the water breaks (a gush of yellow-brown fluid). RECORD THIS TIME. This is the clock that matters.
• Within 5 minutes of the water breaking: a white or bluish-white, translucent, glistening membrane (the amnion) should appear at the vulva, usually with one front foot inside it.
• Within 10 minutes: two front feet, soles pointing down, one foot a few inches ahead of the other, followed by the nose resting on the knees.
• By 20 minutes: the foal should be delivered, or nearly so. Most normal deliveries take 10 to 15 minutes.
• If nothing has appeared at the vulva within 10 minutes of the water breaking, or if progress stops for more than 5 minutes at any point, or if anything looks wrong (see below), call your vet immediately. Do not wait for the 20-minute mark to make that call.
• After 30 minutes, the odds for the foal fall sharply and continue to fall with every additional 10 minutes.
• RED BAG: If a thick, velvety, RED membrane appears at the vulva instead of the white membrane, the placenta is separating before the foal is out and the foal is suffocating. This is an emergency within the emergency. Cut (with scissors)or tear open the red membrane immediately and deliver the foal. Do not wait for your vet to arrive.

• Call your vet immediately. Tell them the time the water broke, what you see at the vulva (membrane color, feet, nose, how many feet, which way the soles face), and whether the mare is straining. Put the phone on speaker and keep the line open. Follow their instructions exactly. Do not hang up and try things on your own.
• Get help. Foaling problems are very hard to manage alone. Call anyone nearby who can hold the mare, hold the phone, or hold a flashlight.
• Note the time and keep tracking it. Tell your vet how much time has passed with each update.
• Halter the mare and get her under control. If she is down and pushing, let her stay down. If she is up, have someone hold her.
• Keep the mare as calm and quiet as possible. Dim lights, quiet voices, minimal traffic.
• Prepare while you talk to your vet: wrap the tail, wash the vulva and surrounding area with warm water and mild soap, rinse off soap, wash your hands and arms to the shoulder, have plenty of obstetric lubricant (or clean liquid soap if that is all you have) ready. Remove rings and watches. Be sure rectal sleeves are available.
• If your vet asks you to check the foal's position: with a clean, well lubricated hand and arm, gently feel inside the vagina for what is presenting. A normal foal presents as two front feet, soles down, one slightly ahead of the other, with the nose on top of the front legs (knees). Report exactly what you feel: how many feet, soles up or down, whether you feel a head, a tail, or nothing. Do not guess. Describe.
• If the foal is in the normal position and the mare is pushing but progress is slow, your vet may direct you to assist by pulling. Grasp both front legs above the fetlocks (or with clean soft ropes or a towel if they are slippery), and pull ONLY when the mare pushes, resting when she rests. Pull one leg slightly ahead of the other to ease the shoulders through. Pull downward, toward the mare's hocks, in an arc, never straight back and never upward. Once the hips are through, stop pulling and let the foal slide out.
• If the foal is NOT in the normal position (one leg back, head turned back, upside down, tail or hind feet first, more than two feet), tell your vet exactly what you find. They will direct you on whether to attempt to correct it, walk the mare, or prepare to transport. Do not attempt corrections without guidance.

NEVER PULL THE FOAL WITHOUT CORRECTING MALPOSITION/PRESENTATION. EXCESSIVE FORCE(beyond what 2 strong adults can provide) WILL INJURE OR KILL THE MARE. MORE FORCE IS ALMOST NEVER THE ANSWER.
• If your vet is on the way and instructs you to slow labor, walking the mare can reduce her straining while you wait. Follow their instructions on this.
• If your vet asks you to bring the mare in, load her now. A mare in stage 2 labor can usually be trailered. Time spent debating is time the foal does not have.
• Once the foal is out: clear the membranes from its nose and mouth immediately, rub it vigorously with a towel, and confirm it is breathing. Leave the umbilical cord attached and let it break on its own as the mare or foal moves. Then call your vet back with an update.
• After delivery, note the time the placenta passes. It should pass within 3 hours. If it does not, that is another emergency call.
• Expect your vet to examine both mare and foal after any assisted or prolonged delivery, even if both seem fine.

What Not To Do

• Do not intervene unless you have tried to reach your vet and they are not available to help and you are confident in what you are doing.
• Do not wait and see. If nothing is happening 10 minutes after the water breaks, or progress stops, call your vet and get them on their way. Do not wait for the 20-minute mark.
• Do not attempt to pull the foal before you know its position, and do not pull unless your vet has told you to.
• Do not pull when the mare is not pushing, and never pull straight back or upward. Pull downward toward the hocks, timed with her contractions.
• Do not pull on one leg only, and never pull on the head alone. Pulling on a foal that is malpositioned can kill the foal and tear the mare.
• Do not use excessive force, and never use a vehicle, winch, or come-along. If two people pulling with the mare's contractions cannot deliver the foal, something is wrong that force will not fix. Mares are easily critically injured, not nearly as forgiving as cows or some other species!
• Do not push the foal back into the mare unless your vet directs you to.
• Do not give oxytocin or any other drug unless your vet directs you to.
• Do not put a dirty hand or arm into the mare. Wash first and use plenty of lubricant.
• Do not cut the umbilical cord once foal is out. Let it break on its own.
• Do not assume all is well because the foal is out. Prolonged labor causes problems for both mare and foal that may not show up for hours to days. Have both examined.
• Do not try to manage this alone if there is any way to get help.

your vet's role

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• Triage by phone: your vet will ask a fast series of questions to judge how far along things are, what the foal's position likely is, and whether you can safely assist. Based on your answers and the time elapsed, they will decide whether to talk you through delivery, come to you, or send you to a hospital.
• Ongoing phone guidance: if they cannot reach you in time, your vet may guide you through checking presentation, correcting a simple positioning problem, and applying traction correctly. Stay on the line.
• On arrival: your vet examines the mare, determines the foal's presentation and whether it is alive, and usually sedates the mare and may give an epidural to reduce straining and allow safe manipulation.
• Correction and delivery: most dystocias involve a foal that is positioned wrong (a leg back, a head turned back, hind feet first, or a "dog-sitting" foal). Your vet repositions the foal inside the mare, often pushing it back in first to make room, then delivers it with controlled traction. This is physically demanding, time-limited work.
• Referral: if the foal cannot be delivered within a few minutes of manipulation, your vet may send the mare to a hospital for delivery under general anesthesia (with the mare's hindquarters elevated), a cesarean section, or, if the foal is already dead, a procedure to remove it in pieces (fetotomy) to save the mare. The decision to refer is made early because delay costs foal and mare.
• After delivery: your vet examines the foal for the effects of oxygen deprivation and for injuries such as fractured ribs, and often runs a blood test for antibody (IgG) absorption at 12 to 24 hours. The mare is examined for tears, bruising, and internal bleeding, the placenta is examined in full to confirm it is complete, and the mare is monitored for retained placenta, uterine infection, and laminitis, which are all more common after a difficult foaling.
Questions Your Vet Might Ask:
  • Has anyone attempted to pull the foal? How, and with what result?
  • Is this the mare's first foal? Has she had foaling trouble before?
  • Is the mare lying down, actively pushing, or is she up? Up and down?
  • Is the mare actively straining, or has she stopped pushing?
  • What do you see at the vulva right now: a white/translucent membrane, a red velvety membrane, feet, a nose, or nothing?
  • Have you put a hand in to feel the foal? What did you feel?
  • How many feet do you see, and are the soles pointing down (toward the ground) or up?
  • When did you first see the pale fetal membranes (water bag)?
  • Can I have your location and directions to get to you as soon as possible?
  • Do you see premature placental separation or red bag?
  • Can you see the foal's feet or head?
  • What is the mare doing currently?
  • When did the water break?
  • How far along is she? What was her breeding date or expected due date?
  • Did she have any problems during the pregnancy, such as vaginal discharge, udder development too early, or dripping milk?

further reading & resources

Author: Doug Thal DVM Dipl. ABVP