Key Insights
  • The post-foaling period is a high-risk transition window in which early detection of problems is critical for both mare and foal survival
  • The 1-2-3-4 Rule provides simple, time-based benchmarks that help breeders identify abnormalities requiring immediate veterinary intervention
  • Foals should stand within 1 hour and nurse within 2 hours to ensure adequate coordination, energy intake, and passive transfer of immunity
  • Failure to nurse promptly can lead to failure of passive transfer, significantly increasing the risk of infection and neonatal illness
  • Mares should pass the placenta within 3 hours; retained placental tissue is a life-threatening emergency associated with metritis, laminitis, and septicemia
  • Foals should pass meconium within 4 hours, as delayed passage can cause discomfort, colic, and intestinal obstruction
  • Conditions such as neonatal encephalopathy, musculoskeletal abnormalities, prematurity, and dysmaturity commonly interfere with early standing and nursing
  • Close monitoring during the first hours after birth, followed by a veterinary examination at 18–24 hours, supports early intervention and long-term health outcomes

The post-foaling period is a critical phase in the life of both mare and foal. This period spans the first few hours after birth, during which various developmental milestones occur.

For the foal, immediate post-foaling benchmarks include standing, nursing, and bonding with their dam. Nursing provides essential colostrum rich in antibodies that confer passive immunity against diseases.

For the mare, post-foaling concerns include the expulsion of the placenta, which should ideally happen within a few hours after birth. If the placenta is not passed promptly, immediate veterinary intervention is necessary to avoid serious complications.

Monitoring the health and behavior of both mare and foal is paramount after foaling to ensure that any health issues are promptly addressed. By understanding these key post-foaling milestones, horse owners and breeders can support the long-term health of their horses.

Post-Foaling Benchmarks: 1-2-3-4 Rule

It’s important for breeders to observe all foalings as closely as possible to monitor the health and wellness of the mare and foal during this period of rapid transition.

The 1-2-3-4 Rule is a helpful guideline for breeders to follow when evaluating their mare and foal after delivery. This allows them to identify issues quickly for prompt veterinary intervention and better outcomes.

The 1-2-3-4 Rule is:

  1. Foals should stand within 1 hour after birth
  2. Foals should suckle within 2 hours after birth
  3. Mares should pass their placenta by 3 hours after birth
  4. Foals should pass meconium by 4 hours after birth

Failure of the mare or foal to meet these guidelines is a medical emergency requiring immediate veterinary intervention to prevent potentially life-threatening conditions from developing. Mares and foals that successfully meet these guidelines should be evaluated by a veterinarian at 18 – 24 hours after foaling.

Hour 1: Foal Standing

Newborn foals should sit sternal (sitting upright on their chest) within the first 1 – 2 minutes after being born. [1] They will sit sternal for several minutes, and often start making suckling movements of the mouth and tongue during this time. [2]

As the mare starts to clean off the foal, the foal extends their forelimbs and makes initial attempts to stand. [2] They should successfully stand within the first 60 minutes after delivery. [1]

Some foals may take slightly longer than an hour to stand, however taking longer than 2 hours to stand successfully is abnormal. [1][2]

There are several potential reasons a foal may be slow or unable to stand after birth, including: [2]

Neonatal Encephalopathy

Neonatal encephalopathy, or dummy foal syndrome, refers to foals who show neurological abnormalities at birth or shortly after birth. [3] The exact cause of neonatal encephalopathy is unknown; however, foals can show signs of low oxygen and inflammation within their brain. [3]

Foals with dummy foal syndrome are often slow or unable to stand after birth. [3] They also display additional neurological signs such as: [3]

  • Lack of interest in the mare
  • Lack of a suckling reflex
  • Uncoordinated movement if able to stand
  • Tremors
  • Seizures
  • Tongue protrusion
  • Abnormal breathing patterns

Risk factors associated with the development of dummy foal syndrome include: [3]

  • Placentitis or premature placental separation
  • Bacterial infections
  • Twinning
  • Prematurity or dysmaturity
  • Compression of the umbilical cord
  • Dystocia (difficulty giving birth)

Treatment for dummy foal syndrome is primarily supportive, as there are no known treatments currently available. [3]

Some breeders and veterinarians have successfully used the Madigan squeeze technique, which mimics the squeezing of the foal that occurs in the birth canal. [3] Additional squeezing may stimulate the transition from unconsciousness within the uterus to consciousness that normal foals go through during birth. [3]

Musculoskeletal Abnormalities

Musculoskeletal abnormalities are common in newborn foals, particularly abnormalities affecting the tendons or positions of the bones. [2] Within the uterus, the long limbs of foals are folded up into a tight space, which can lead to abnormal development. [2]

Flexural Deformities

The most common musculoskeletal abnormalities in foals are flexural deformities, where the tendons are too short, and angular limb deformities, where the bones have an abnormal position relative to each other. [2]

Foals with flexural deformities have flexed legs that typically cannot be fully extended. [2] This flexion results from inability of the tendons on the back of the leg to stretch and accommodate the full length of the leg. [2]

Some foals are unable to stand due to the extreme flexion. [2] Treatment can involve bandaging or splinting to slowly stretch out the tendons to a more effective length. [2]

Angular Limb Deformities

Angular limb deformities in newborn foals usually result from laxity in the tendons or ligaments that hold the leg bones in alignment with each other. [2]

When observing the foal from the front or back, the leg will appear deviated either towards the middle (varus) or outward (valgus) at a particular joint. [2] Some owners refer to these conditions as bowlegged or knock-kneed, respectively. [2]

In cases of musculoskeletal abnormalities, foals may have difficulty standing or will be unsteady on their feet. [2] Many foals outgrow angular limb deformities over time as the tendons and ligaments mature, however some may require surgical intervention to ensure the bones grow straight. [2]

Prematurity and Dysmaturity

Prematurity refers to foals born prior to 320 days gestation, while dysmaturity refers to foals born at a normal gestational length who are not fully developed. [2] These conditions usually result from inadequate nutrient exchange between the mare and foal in utero. [2]

Causes can include: [2]

  • Maternal illness
  • Placentitis
  • Premature placental separation
  • Twinning

Premature and dysmature foals are typically small, weak, and have extreme laxity of their tendons and ligaments. [2] Some also have poor development of the cardiovascular and respiratory system, causing difficulty breathing and weak pulses. [2] Due to these factors, premature and dysmature foals may be unable to stand or require assistance standing. [2]

Many premature and dysmature foals also have incomplete ossification (bone tissue development) of the bones in their knees and hocks. [2] Standing on these immature bones can result in bone collapse and permanent limb deformity. [2] These foals require splinting or casting of the limb to allow them some mobility while their bones mature. [2]

Hour 2: Foal Suckling

Once the foal can stand successfully, their coordination gradually increases, and they should begin seeking the mare’s udder. [2] Mares often help the foals find the udder through gentle nudging. [2]

Foals should begin nursing by 2 hours after delivery. [1] Taking longer than 3 – 4 hours is abnormal and requires intervention. [1] Foals who do not nurse within the first 24 hours after birth will develop failure of passive transfer, a potentially life-threatening condition. [4]

After their first feeding, foals usually lie down and sleep. [2] For the first week of their life, foals should suckle 5 – 7 times an hour in between periods of sleeping and activity. [2]

Failure of Passive Transfer

Failure of passive transfer (FPT) refers to foals who do not drink adequate amounts of good quality colostrum during their first 12 – 24 hours of life. [4]

Colostrum, the mare’s first milk, contains high levels of antibodies that are necessary to protect the foal against infectious diseases until it develops its own immune system. [4] Foals can only absorb antibodies through their intestine effectively during the first 12 hours of life. [4]

Causes of FPT include: [4]

  • Weak or sick foals that do not ingest enough colostrum
  • Premature birth, resulting in mares producing a lower quality colostrum than a term birth
  • Mares that naturally produce low-quality colostrum
  • Poor absorption of antibodies in the intestinal tract after ingestion due to stress or illness
  • Mare rejection of the foal, preventing nursing

Veterinarians can evaluate for failure of passive transfer using a blood test that detects antibody levels in the foal’s bloodstream. [4] Foals that have low antibody levels require intervention to provide them with additional antibodies. [4]

If FPT is recognized after less than 12 hours after birth, intubating colostrum into the foal can provide them with antibodies. [4] After 12 hours, foals require a plasma transfusion to ensure delivery of sufficient antibodies. [4]

Hour 3: Mare Passes Placenta

Mares typically pass their placenta 3 – 4 hours after delivery of the foal. [2] After the mare passes her placenta, the breeder or veterinarian should perform a placental evaluation to ensure the entire placenta is present and there are no significant abnormalities. [2]

Veterinary intervention is necessary if: [2]

  • The placenta does not pass after 6 hours
  • The placenta is incomplete
  • There is evidence of placentitis, infection of the placenta

To evaluate the placenta, the breeder or veterinarian positions the placenta with the red, velvety side of the placenta (chorion) facing outwards. [2] By manipulating the placenta, the evaluator can position the placenta in an “F” shape, allowing for thorough evaluation of the placental membrane. [2]

Once the placenta is positioned, the evaluator carefully examines for tears or missing fragments of placental tissue. [2] The most common location for tears is the tip of the uterine horns, particularly in the uterine horn that did not contain the foal. [2] If placental tissue is missing, the mare requires immediate treatment for a retained placenta.

The evaluator also examines the placenta’s color and texture for signs of placentitis. [2] Placentitis can cause thick, pus-like or brown mucoid material on the surface of the chorion. [2] The bacteria and fungi that cause placentitis can cause life-threatening infections in the newborn foal that require prompt veterinary intervention. [2]

Retained Placenta

If a mare does not pass her placenta by 6 hours after delivery, or there is evidence that a piece of placental tissue remains within the uterus after delivery, the mare has a retained placenta. [2] Between 2 – 10% of foalings result in retained placenta. [2]

There are many potential causes of a retained placenta, including: [4]

  • Breed predisposition
  • Dystocia (difficulty giving birth)
  • Placentitis
  • Poor uterine contractions
Retained placenta is a life-threatening emergency and requires immediate veterinary intervention.

The reason retained placenta presents a significant danger to the mare is the tissue remaining within the uterus undergoes autolysis (self-destructs) and becomes a suitable environment for bacterial growth. [2] As bacteria proliferate within the uterus, they produce toxins that can cross the uterine wall and enter the bloodstream, causing severe disease in the mare. [2]

Potential outcomes of untreated retained placenta include: [2]

  • Metritis: infection of the uterine wall
  • Laminitis: separation of the coffin bone from the hoof wall
  • Septicemia: bacterial infection in the bloodstream
  • Death
Breeders should never attempt to remove a retained placenta, even if parts of placental tissue are visible hanging out of the mare’s vulva.

Placental tissue is extremely fragile and attempting to pull on the tissue will likely result in tearing. [2] If a large amount of placental tissue is hanging from the vulva, the breeder can tie the tissue into a knot to prevent the mare from stepping on the tissue while they wait for a veterinarian. [2]

To treat a fully retained placenta, the veterinarian administers oxytocin to increase the strength of uterine contractions. [2] It can take 1 – 2 hours for the uterine contractions to free the placenta successfully. [4] Filling the placenta with sterile water can also activate stretch receptors within the uterus that increase the strength of contractions. [4]

In cases where only a fragment of the placenta is retained, oxytocin combined with repeated uterine lavages is often effective at dislodging the fragment. [4] Rinsing also removes bacteria, making the environment unsuitable for bacterial growth. [4]

Other treatments recommended for retained placenta include: [4]

  • Antibiotics to prevent septicemia
  • Anti-inflammatories to reduce the risk of laminitis and the effects of bacterial toxins
  • Icing the hooves to prevent laminitis
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Hour 4: Foal Passes Meconium

Meconium is the foal’s first fecal material. [2] Foals typically first pass meconium at around 4 – 6 hours after birth and continue to pass the material for 12 – 24 hours. [2] Passing soft yellow and pasty “milk feces” after 24 hours indicates that all of the meconium has passed, and the foal is producing feces properly. [2]

Some foals fail to pass meconium, causing it to accumulate in the colon causing discomfort. [2] Foals with meconium impaction require intervention to remove the accumulated fecal material and restore normal function to the gastrointestinal tract. [2]

Meconium Impaction

Meconium impaction can occur in any foal, however sick foals have a higher risk due to poor movement of their intestinal tract. [2]

Impaction is uncomfortable for the foal, and they typically display signs of restlessness, pacing, and straining to defecate. [2] Symptoms typically occur after each milk meal, as nursing stimulates defecation in young animals. [2]

Breeders can use a warm, soapy water enema to resolve mild impactions under the guidance of their veterinarian. [2] Phosphate enemas available over the counter can also be used, however they should not be used repeatedly as the phosphate can cause electrolyte imbalances. [2]

If symptoms continue after several enemas, direct veterinary involvement is necessary.

In severe cases, foals can show violent signs of colic, such as thrashing, pawing, and rolling. [2] Some foals may have a bloated appearance in their upper flanks. [2] These foals require immediate veterinary intervention to remove the obstruction. [2]

Veterinarians may administer an acetylcysteine enema, which contains a medication that breaks down mucus within the meconium. [2] They can also administer oral laxatives to stimulate gastrointestinal movement. [2] Some foals may require surgical intervention to remove the impaction. [2]

Frequently Asked Questions

Here are some frequently asked questions about post-foaling benchmarks in horses:

Summary

Breeders can use the 1-2-3-4 Rule to determine whether their mare and foal are meeting the expected post-foaling benchmarks.

  • Mares and foals who do not meet these benchmarks require emergency veterinary intervention.
  • Failure to meet these benchmarks can result in potentially life-threatening conditions.
  • Veterinarians recommend close observation of all foaling events.
  • All mares and foals require a wellness examination at 18 - 24 hours after foaling, even if they meet the benchmarks successfully.
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References

  1. Madigan, J. E., Manual of Equine Neonatal Medicine. Third Edition. Live Oak Pub. 1997.
  2. McKinnon, A. O. et al., Equine Reproduction. Wiley-Blackwell. 2010.
  3. Toribio, R. E., Equine Neonatal Encephalopathy: Facts, Evidence, and Opinions. Veterinary Clinics of North America: Equine Practice. 2019. View Summary
  4. Brinsko, S. P. and Blanchard, T. L., Eds., Manual of Equine Reproduction. 3rd ed. Mosby/Elsevier, St. Louis, Mo. 2011.