"My mare foaled this morning and she hasn't passed the placenta yet. Is there something I can do to help her?" the woman's concerned voice came over the phone. I glanced at the clock on the wall: 6:30 p.m.

"When did she foal?" I asked.

"I don't know for sure, the foal was up and nursing when I found them around 6 this morning. Everything looked fine, so I went to work. I just got home and the membranes are still hanging out of my mare. She looks good otherwise. Should I be concerned, or can you come out in the morning?"

"I'll be right out," I said. Mares who do not pass their placentas within an hour or two of giving birth risk life threatening laminitis. When the fetal membranes are retained in her uterus, cascading endotoxic events cause catastrophic structural changes in her feet which can be severe enough to cause her to shed her hooves. Systemically, she may become quite ill as well. Retained fetal membranes are an emergency; for the health and life of the mare, it is imperative that she be seen as soon as possible.

I told my husband, Derek, what was going on as I packed the medications and equipment I'd need. "Do you want company?" he asked. He is quite useful in emergency situations and I gratefully accepted his offer. I thanked the good Lord for blessing me with a spouse who seems to be completely and cheerfully understanding of demolished dinner plans.

We arrived at the scene to see the glossy bay mare placidly grazing the fresh green grass, her bright sorrel foal sleeping blissfully at her feet. The peaceful view marred only by the amniotic sac draping out from under her tail.

Doris, the owner, haltered the mare and led her over to us. The foal raised its head and nickered as its mother moved away from it.

"Is it a filly or a colt?" I asked as I pulled a pair of long plastic gloves on and cautiously approached the mare's hind quarters. Doris didn't know; she hadn't had time to check.

The mare did not mind my examination so I grasped the membranes and applied gentle traction. She pushed. I pulled a little more, encouraged by her cooperation and the sense I got that the placenta was starting to slip slowly out. She pushed hard, grunting with the effort; I assisted her and we seemed to be making good progress. Suddenly the placenta burst out of the mare, but I knew almost instantly that it wasn't just the placenta; the mare's uterus had prolapsed along with the placenta. I quickly sedated the mare so she'd stop pushing and she lay down on the soft green grass.

It is exceedingly rare and terribly life threatening for a mare to prolapse her uterus. I needed to get the placenta freed from the uterine lining and replace the uterus in her abdomen as soon as possible. Derek worked with me to peel the placenta from the uterus while I planned the next step. I realized quickly that the uterus was becoming larger and larger as we hurriedly detached the placenta.

The large and muscular arteries carrying blood into the uterus were working just fine, but the softer veins returning the blood to her body were essentially collapsed by the constricting birth canal. This resulted in the uterus becoming distended with blood as we struggled to remove the membranes. I glanced up at Doris. A memory from James Herriot's book "All Creatures Great and Small" had come to my mind, and I asked her if she could get 5 or 10 pounds of sugar from the house. She dashed off to do my bidding while Derek looked at me with unspoken questions in his eyes.

Finally the placenta was free, but the uterus appeared to be growing by the second. Doris returned with the sugar, and I dumped it on the engorged uterus, hoping the sugar would absorb the edema and shrink it enough to allow me to replace it in the mare.

Some blood started to spurt from the uterine wall. I clamped the bleeding vessel and another started to bleed. Soon there were dozens of bleeders from the pressure of the blood in the uterus. I rocked back hopelessly on my heels and watched with dismay as this new disaster unfolded. There was no way I could clamp off the bleeders and I knew the mare would soon bleed to death.

I gazed over at the foal sleeping in the grass, blissfully unaware of the calamity that would soon befall its life. The mare was in her late twenties and probably shouldn't have been foaling -- her age likely contributed to the uterine prolapse. I explained the situation to Doris and she agreed to let me put the mare down. Deeply dejected, I walked back to my car to get the fuchsia euthanasia fluid and pulled up the appropriate dose in a large syringe. I sighed heavily, very sad that this beautiful day was soon to be marred by tragedy. I returned to the side of the still recumbent mare and checked on her uterus one last time.

I stopped and stared; the sugar covered uterus actually seemed smaller and it was no longer spurting blood. Inspired by impossible hope, I dropped the deadly syringe, knelt behind the mare, picked up the uterus and gently slipped it back inside her. It seemed to want to return to its rightful place and offered no resistance. I recognized that while things looked vastly better with the uterus out of sight, it was still bleeding although not so profusely as before. Oxytocin would cause her uterus to clamp down hard and I believed that would stop the bleeding.

I looked at Derek, "Can you give her 5 cc's of oxytocin IV or do you want to try to keep her uterus from coming back out?" I asked him. His eyes widened a bit, "I've never given an IV injection before." he answered, making his choice. I grabbed a syringe and filled it with oxytocin; he took his place behind the mare, hand and arm deeply imbedded in her birth canal, ready for her to respond to the injection. I gave the hormone and her uterus, full of receptors that were ready for that drug, nearly instantly clamped down. Derek was astonished at the reaction and feared momentarily that he might not get his hand back.

Soon, as the sedative wore off, the mare raised her head and nickered for her foal. The bleeding had stopped and she was no longer pushing in response to the medication. We helped her stand up when she was ready. Her foal scrambled to its feet and scampered over to her side tucking its head under her belly and began to nurse vigorously. I lifted its tail and exclaimed, "It's a girl!" The new filly and her mother were clearly content as we picked up our debris. I could not remember a more satisfying outcome in my life.

Tia Nelson is a local veterinarian specializing in an integrated approach to animal health that combines traditional veterinary medicine with holistic, natural practices.