In a foaling stall at Shamrock Farm in Woodbine, Md., Christie Steele rubbed the filly with a towel, wiped her nose, put her in a blanket, got her under heat lamps. But the filly didn’t really respond, not the way most foals do. She didn’t stand, didn’t bond with her mother, didn’t instinctively start to suck.

Steele had seen it before. A “dummy” or maladjusted foal falls behind in its first hours and requires around-the-clock care–bottle feeding, constant attention, a visit from a veterinarian and perhaps a trip to a clinic for more aggressive treatment. Usually, the foal improves enough to start nursing and gets healthy, but it can be a long process and a dangerous game to play with a young horse’s life.

“Time is of the essence because they’re little tiny babies,” said Steele, who sees about two dummy births from 60 foalings a year. “They can be long, drawn-out cases, very labor intensive and the things you do don’t always work.”

But on March 23, with this filly, Steele did something that worked. She’d seen an online video about a foal “squeezing” technique developed by Dr. John Madigan at the University of California, Davis. The theory is that dummy foals never receive the proper biological trigger to come out of the deep sleep they’re in before birth. Steele watched the video, read up on the technique at the UC Davis website and tried to understand the hows and whys.

With a premature filly and not much time, she tried to copy Madigan’s technique–looping a rope around the foal’s chest and girth and tightening. The rope is nothing new, it’s the same procedure cattle farms use to make cows lie down to be treated, though it’s a little different with baby horses.

Wrapped in blankets and being so small, Steele’s filly didn’t go through the stages Madigan described in the video–didn’t fall asleep, didn’t bounce back to life and start nursing, didn’t nicker for her mother.

Steele kept trying. The squeeze is supposed to mimic the 20 minutes of stage two labor, where the foal passes through the birth canal.

“I’m in the equipment room looking for something we can make smaller than that rope,” she said. “I’ve had my arms in a mare, I know how tight it is in there. This foal was lying down and was so small, maybe we weren’t getting it tight enough.”

While rummaging through the various pieces of tack and supplies on a typical breeding farm, Steele found a Miracle Collar cribbing strap for an adult horse.
“I had to punch another hole in it because the filly was so small,” said Steele. She tightened the strap. The filly flopped over on her side, as if hit with a tranquilizer dart, asleep.

“I set my timer for 20 minutes because that’s what was in the information,” Steele said. “We were sitting with her, making sure she was OK, and in 15 minutes she woke up. We did the full 20 minutes, took the strap off and she sat up and immediately wanted to nurse. Instead of taking 2 ounces or 1 ounce like she was, she took the full 8-ounce bottle.”

And has been improving ever since. The filly went to New Bolton Center for some evaluation, to Heritage Stallions so her dam could be bred, and returned to Shamrock where she’ll be raised with the other foals of 2015.

“We felt like she wasn’t going to make it,” Steele said. “It was a life or death situation as far as I was concerned. She acted better right after we did the squeeze, and we were able to get her going forward where she was progressing and acting like she wanted to live.”

Dummy Foals Explained

Veterinarians used to think dummy foals had been deprived oxygen, hence the lethargy, delayed responses, lack of otherwise natural movements and sounds. With around-the-clock care, bottle or tube feeding and other treatment, many foals recovered in a matter of days, but it was work and there were no guarantees.

Madigan, a UC Davis veterinary professor and an expert in equine neonatal health, never quite bought the oxygen theory.

“They recover too well too fast for it to be low oxygen,” he said in April.

Now, thanks to various studies and experiments–some related to dummy foals and some not at all–the culprit is a natural substance which sedates foals in the womb. Foals sleep through much of the pregnancy. Something has to keep them that way. Just as important, something has to tell them to wake up after passing through the birth canal. And for horses, the transition is key as they can stand, nurse and walk within an hour of birth and in the wild must be prepared to run within hours.

The neurosteroid is powerful and works on the same receptors in the brain as anesthetics and sedatives used in surgery or other cases. Studies revealed high levels of the substance in maladjusted foals. That science helped fuel experiments and a study on the mechanics involved in the relaxation caused when foals (and other mammals) are held snugly. Seeking consistency, Madigan created the rope device. Researchers measured the neurosteroid levels before and after the squeeze and they changed dramatically.

“It’s evolution,” Madigan said. “When you get squeezed like this you can’t move around, your heart rate slows, everything. We mimicked that and I thought ‘What if some of these foals with maladjustment had a quick delivery?’ What if they missed the signal to stop making this stuff that was making them sleep? They’re asleep in the womb, they go through the birth canal where it’s so tight they can’t move and in one hour they have to stand up and run around. The system has to start somewhere and the sedation has to be turned off.”

Madigan said the theory is supported by higher instances of neonatal maladjustment in foals delivered by Caesarean section and in rapid deliveries.

Madigan pointed to a handful of key indicators. The foal might not want to nurse, has trouble standing, doesn’t move away from humans, doesn’t identify with its mother.

“If the foal looks like he’s back in the womb, all curled up, that’s a signal,” he said. “Maybe he’s full of the stuff that made him be that way in the womb. It makes a lot of common sense, rather than being a wild idea. They’re sedated in utero, immobilized in the birth canal and then they have to run around and nicker and stand and be ready. The whole idea is we’ve been presuming everything would go right and of course there are a whole lot of things that don’t go right.”

All veterinarians will agree with that statement, though they will also caution against considering any treatment a cure-all. The foal-squeezing technique addresses only the most mild effects of neonatal maladjustment syndrome, which can include issues with breathing, an inability to stand or walk, kidney problems, gastro-intestinal problems and more.

“It is fairly complex, and a multi-symptom disease,” said Dr. Jon Palmer, chief of the neonatal intensive care service at the University of Pennsylvania’s New Bolton Center. “I think they’re on the right track with the neurosteroids being part of the problem, but many people have been looking for an on/off switch for this and it’s probably more complicated.”

Palmer has clients who have used the squeeze technique and seen positive results. He’s also seen foals regress after the procedure. He does not necessarily see a parallel between quick deliveries and dummy foals, but also appreciates the science behind Madigan’s theory.

“The idea that neurosteroid levels are not the right levels, I buy that,” Palmer said. “Why they’re not the right levels, we don’t know.”

Practical Examples

In 2012, Madigan’s theory got a push. He took a call from a client with a dummy foal. It was eight hours old, wasn’t nursing, wasn’t progressing. Madigan asked about the birth, and was told it was very fast.

“Hey, you want to try something that won’t cost any money?” he asked.

“Sure,” the client replied.

“You got a rope…?”

Madigan drove to the farm and the foal was “goofy.” They couldn’t wake him up. He’d suckle a bottle, a little, but wouldn’t nurse on the mare at all. Madigan got the rope, squeezed the foal for 20 minutes and unhooked the rope.

“He woke up and nickered at the mare,” Madigan said. “And I just saw him on the racetrack. He’s a 3-year-old, a completely normal horse.”

Since then, Madigan has lectured veterinarians and horsemen on the topic, launched a clinical trial to add more science to it, seen some parallels drawn to the care of human infants with autism, hosted a film crew from The Secret Life of Babies and generally tried to spread the word.

After success with the first filly, Steele had a squeeze girth–the smallest three-strap-and-buckle girth you’ve ever seen–made by Barb Carr of Sew What Blanket Wash and Repair. It got its first use not long after it entered the tack room.

Standardbred mare Bootleg Yankee delivered a filly in a normal–but fast–foaling April 8. The filly was fine, started out strong, but became reluctant to nurse and didn’t thrive. There were no early dummy symptoms, just a lack of progress. She was going to live, but she was going to take some work. Steele figured there wasn’t much to lose.

“She would take some bottles, but would peter out and she wouldn’t really nurse on the mare,” said Steele. “I put the squeeze girth on, and she went down–out like a light. I took it off after 20 minutes, woke her up, got her up and pushed her over to the mare and damned if she didn’t latch right on and start nursing.”

The treatment helps ease the commitment to care for a dummy foal with bottle feeding and other steps while delaying a potential trip to a veterinary clinic.
Steele, Madigan and Palmer cautioned about squeezing a foal with potential rib injuries from a difficult delivery and also said to be sure to conduct the squeeze in the center of the stall to prevent the foal from hitting a wall.

Steele hopes to see the procedure become common practice.

“We’re all in this together,” she said when asked about other farms using the squeeze technique. “We’re competitive, but we’re really after the goodwill of the animal and the industry. We need to be more open and honest about things like this, not less.”

Now What?

Success stories make for good anecdotes, but the science will continue.

UC Davis is conducting a clinical trial to evaluate the effects of the squeeze in a randomized trial. Foals must show signs of neonatal maladjustment syndrome and must not have a rib fracture, respiratory distress, shock, sepsis, congenital anomalies and other conditions. Instructions on how to participate are on the UC Davis website, vetmed.ucdavis.edu.

The squeezing, the ropes, the people, the horses involved can’t be standardized, but a trial will help improve the science. The syndrome will always be difficult to quantify. Foals sometimes improve on their own, in hours or days. Foals sometimes stop making progress and the symptoms return.

“One problem in studying this is it spontaneously resolves,” said Palmer, who recalled a time when medication was considered the answer for dummy foals. In one case, a foal normalized and started nursing while Palmer was preparing the injection. “Another minute and I would have thought it was the medication that did it.”
As with all veterinary procedures, caution will be a key. Be careful, be slow, be methodical, get advice from experts before you try something with which you’re unfamiliar.

“I tell [clients] they need their vet to look at it thoroughly,” said Palmer. “Is it really a dummy, or are there other things going on. If they want to try the squeezing technique I would suggest they do it with their veterinarian in case something goes wrong. But I would also tell them, keep looking at what happens later. Just because there seems to be a response they need to keep a very close eye on that foal.”