When a mare is in trouble during foaling, a referral hospital might be the best option for survival of the mare and foal. Dystocia (difficult birth) is a true emergency where minutes count, emphasized Rolf Embertson, DVM, Dipl. ACVS, of Rood and Riddle Equine Hospital in Lexington, Ky., in his presentation "Dystocia Management" during the in-depth session on "The Foal: Birth to One Month."

Incidence of dystocia is around 4%, although this varies by breed, Embertson said. While many dystocias are resolved on the farm, some cases need to be referred to a hospital. This decision should be made based on the position of the foal, duration of the dystocia, distance to and preparedness of the referral hospital, and the experience of the farm's foaling personnel and veterinarian.

Embertson said that at Rood and Riddle, all on-call staff should be within 15-20 minutes of the clinic while on call. When they are notified of an incoming dystocia, the dystocia and neonate teams can organize and be prepared for the mare within 20 minutes. The mare is brought into an induction stall, where she is quickly examined. Usually, assisted vaginal delivery (AVD) has been attempted at the farm. This is when foaling personnel have tried to assist the mare by manipulating the foal through her vagina.

Controlled vaginal delivery (CVD) is the next step at the hospital. The mare is sedated with xylazine and anesthetized with diazepam and ketamine. She is then hooked to a hoist by her back feet ("mare in the air" technique) and her pelvis is lifted three feet from the floor. The veterinarian can then assess the position of the foal and reposition if needed, using the added assistance of gravity to push the foal back into the uterus to give him room to work