Newborn Foal Not Breathing: How to Perform CPR and Save a Foal

By Dr Duncan Houston

When a newborn foal doesn’t breathe, you have minutes, not hours.

This is one of the most time-critical situations in equine medicine.
Most foals that die at birth do not die because the heart stops first. They die because they do not get enough oxygen quickly enough.

The good news is this:
If you act fast and correctly, survival rates improve dramatically.

This guide walks you through exactly what matters, what to do, and what mistakes to avoid.

Quick Answer

If a newborn foal is not breathing or only gasping, immediately clear the airway, stimulate breathing, and begin artificial respiration at about 10 breaths per minute. If the heart rate is below 60 beats per minute, start chest compressions. Continue CPR while calling a veterinarian. Early oxygen support is the most critical factor in survival.

What Is Actually Happening in a Foal That Isn’t Breathing

The physiology behind it

At birth, a foal must rapidly switch from:

• oxygen supplied via the placenta
  to

• breathing independently through the lungs

If this transition fails, oxygen levels drop quickly, leading to:

• brain hypoxia

• organ damage

• cardiac slowing

What this looks like in real life

• No breathing or weak gasping

• Slow or absent movement

• Pale, blue, or grey gums

• Weak or absent suckle reflex

• Low heart rate

The key clinical insight

In practice, the primary problem is almost always oxygen, not the heart.
That is why breathing support comes first.

When Should You Start CPR?

Start immediately if you see:

• No breathing

• Gasping but ineffective breathing

• Respiratory rate less than 10 breaths per minute

• Heart rate less than 60 bpm

• Foal is limp or unresponsive

Decision checkpoint

• If the foal is breathing strongly and trying to stand → monitor closely

• If breathing is weak, irregular, or absent → intervene immediately

The First 60 Seconds: What Actually Saves the Foal

1. Stimulate Breathing Through Drying

Vigorous towel rubbing:

• reduces heat loss

• stimulates the nervous system

• encourages breathing

This is not just drying
This is active stimulation

2. Clear the Airway Properly

Foals are often born with fluid in the airway.

Do this:

• Lower the head slightly

• Wipe nostrils and mouth

• Use a syringe or bulb suction if needed

Critical mistake to avoid

Do NOT hang the foal upside down

This can:

• compress the diaphragm

• worsen breathing

• delay oxygen delivery

3. Umbilical Cord Management

Only clamp if there is active bleeding

Otherwise, leave it
The cord provides additional blood transfer after birth

Artificial Respiration: The Most Important Step

What you are doing

You are manually delivering oxygen to the lungs
to prevent brain and organ damage

How to do it

Method 1: Mouth-to-nostril

• Seal your mouth over one nostril

• Close the other nostril

• Blow until you see chest rise

• Deliver about 10 breaths per minute

Method 2: Ambu bag or mask (preferred if available)

• Provides more controlled airflow

• Reduces risk of incorrect pressure

Key checkpoint

• If the abdomen inflates instead of the chest → airway is not positioned correctly

• Reposition immediately

When to Start Chest Compressions

Only start compressions if:

• Heart rate remains below 60 bpm

• There is no improvement with breathing support

Why this matters

The heart in a newborn foal is usually still capable of working
It is slowed because of lack of oxygen

How to perform compressions

• Place hands just behind the elbow

• Compress chest about 5 cm

• Rate: 80 to 100 compressions per minute

• Combine with breathing in a 30:2 ratio

Reassessment rule

Check every 2 minutes:

• Heart rate

• Breathing effort

• Gum colour

Severity Framework: How Critical Is the Situation?

Mild

• Weak but present breathing

• Responsive

• Heart rate above 60

Monitor closely and support

Moderate

• Slow breathing

• Weak suckle reflex

• Reduced responsiveness

Begin airway support and stimulation

Severe

• Gasping or no breathing

• Heart rate below 60

• Poor muscle tone

Immediate CPR required

Critical

• No breathing

• No detectable heartbeat

• Grey or blue gums

Full resuscitation with urgent veterinary support

What To Do Right Now: Step-by-Step Action Plan

1. Check breathing and heart rate

2. Stimulate with vigorous drying

3. Clear airway

4. Begin artificial respiration

5. Add compressions if HR < 60

6. Call your veterinarian immediately

7. Continue CPR without interruption

What Happens After CPR?

Even if the foal responds, risk is not over.

Why ongoing care matters

Oxygen deprivation can affect:

• brain function

• organ systems

• ability to nurse

What to do next

• Keep the foal warm and dry

• Place in sternal position (upright chest position)

• Monitor:

  • breathing

  • temperature

  • suckle reflex

Time-based guidance

• Monitor closely for 24 to 48 hours

• Any deterioration → immediate vet review

Common Mistakes That Cost Foal Lives

• Waiting to see if the foal improves

• Focusing on the heart instead of breathing

• Poor airway positioning

• Not recognising weak breathing

• Stopping CPR too early

• Delaying veterinary involvement

Prevention: How to Be Ready Before Foaling

Preparation is one of the biggest survival factors.

Essential foaling kit

• Towels

• Bulb syringe or suction device

• Ambu bag or mask

• Gloves

• Stethoscope

• Warm blankets

Practical preparation

• Train everyone involved in foaling

• Have vet contact ready

• Identify high-risk pregnancies early

Frequently Asked Questions

How long should I continue CPR?

Continue until breathing and heart function return or a vet takes over. Do not stop early if there is still a chance of response.

Can a foal recover fully after CPR?

Yes, especially if intervention is early. Delays increase the risk of long-term complications.

Is mouth-to-nostril breathing safe?

Yes, when done correctly. Ensure proper seal and chest rise.

Should I always call a vet even if the foal improves?

Yes. Post-CPR complications are common and need monitoring.

What is the biggest factor affecting survival?

Time to oxygen delivery. The faster breathing is restored, the better the outcome.

Final Thoughts

When a foal is not breathing, this is not a situation to hesitate.

The difference between life and death is often:

• recognising the problem early

• acting decisively

• focusing on oxygen first

Done correctly, CPR does not just save a life
It protects the future health of the foal.

If you are ever unsure whether a newborn foal is breathing normally or needs intervention, ASK A VET™ can help guide you in real time so you can act quickly and with confidence.