Horses rarely have any difficulty giving birth. The process is extremely rapid and usually takes place during the night; the foal should be on its feet shortly thereafter. Mares seem to try to avoid foaling when there are people around and often manage to do so unobserved, unless there is some type of constant watch maintained on the horse. It is normally unnecessary to interfere with or assist the mare in any way at foaling.

During the first stage of labor, the cervix and vagina open. The fetal membrane–the amniotic sac–contains large amounts of fluid in which the fetus has lived and may also be seen. The sac then ruptures when powerful contractions begin during the second stage of labor. The contractions commonly cause the mare some degree of discomfort; signs include restless behavior, such as circling the box, pawing at the bedding, and sweating. They can foal standing up, but more often do so lying down. In most cases, the foal is presented and delivered forelegs first, closely followed by the head, followed soon afterward by the rest of the body. Some mares may rest before expelling the hips with a final effort.

Knowing when something is going wrong with the labor is not easy, especially for someone that is inexperienced. For this reason it may be better to send a mare to foal at a breeding farm, where professional assistance is available if necessary. Even for an amateur, it should be possible to tell from the way the feet are presented whether the foal is coming out forward or backward. If the mare continues to strain violently for a long time without making progress, a check should be made that all is going well by inserting a hand into the vagina. Normally, the head can be felt directly behind the extended forelegs, lying on top of the knees. If all does not seem normal, expert help should be sought out immediately. Sometimes the head may go back and hinder the birth process. Foals are less often born backward, but this usually presents no problems. In the rare case of a breech birth, no legs appear despite considerable straining, and the tail is felt when a hand is inserted. Veterinary help should be sought out immediately, because it requires a considerable amount of expertise to realign the hind legs in a fashion that is ready for delivery. Deformities of foals, particularly contracted limbs, are one of the more common causes of foaling problems. It is better to seek veterinary help soon in cases of trouble–delay is likely to result in death of the foal. The person on the spot should be aware that foals could suffocate if any part of the membrane remains around the nostrils after birth. In this case, the membrane must be cleared away by hand to allow the foal to breathe, and to prevent it from choking.

The umbilical cord contains the large blood vessels, which have been supplying blood and nutrients to, and removing waste products from, the foal before birth. After foaling, uterine contractions compress the placenta, and blood passes from it for the last time down the cord into the foal. It is normally unnecessary to cut the cord; the foal can be left still attached to the cord until it is broken naturally, whether by the mare or by the foal getting to its feet. The placenta is shed in the third stage of labor. If at that time the cord is still attached to the foal, it may be helpful to sever it, approximately one inch from the body. A ligature must be tied around the stump, which should be dressed with iodine or antibiotic powder. Keeping the navel clean is necessary to prevent infection.

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