We perform between two and six caesarean sections, on mares with foaling difficulties, every spring, using a two-team (mare surgical and foal care) approach. The most common indication for equine caesarean section is dystocia (difficulty during foaling) and decision-making at the time of first indication of difficulty must be rapid for the best chance of saving the mare and retrieving a live foal.
The mare is assessed as to whether the foetus (unborn foal) is alive, whether the dystocia is the result of mal-presentation or foetal oversize, or whether there is another reason for the problem. For the mare, results are now good with efficient and expert caesarean section, if admitted early in the course of the dystocia. For the foal, results are also now good with expert neonatal intensive care if it is alive at surgical delivery, if it is ‘ready for birth’ (in terms of dates and maturity) and if the mare is admitted early in the course of the dystocia.
Elective caesarean sections are carried out less frequently, but may be indicated for a variety of reasons, including maternal pelvic abnormality/injury, ventral abdominal rupture and to save a foal when the mare suffers acute catastrophes such as intestinal crises or orthopaedic injuries at full term. In order for the foal to have a good chance of survival it must be ‘ready for birth’.
When admitted for Caesarean section, mares are often in considerable pain and distress. General anaesthesia is required to allow a detailed examination of the foetus in the uterus and birth canal, with the mare unconscious and fully relaxed. In some cases, hoisting the mare’s hindquarters then allows the foetus to be repositioned and delivered per vaginam (through the cervix and vagina). This is called a controlled delivery, which if achievable, relieves the need for a Caesarean section. In other cases, the foetus still cannot be repositioned for vaginal delivery and the mare is then transferred to the operating theatre for Caesarean section, without delay.