A foal born three weeks early after a "red bag" delivery: 29 days in intensive care at a University of California vet hospital, and now he's set to train for barrel racing

What happened

On 30 October 2026 the US veterinary journal dvm360 told the story of a foal called Banks. Citing the University of California, Davis, School of Veterinary Medicine, it reported that the foal was born about three weeks early after what's known as a "red bag" delivery, and spent 29 days in the neonatal intensive care unit at the university's veterinary hospital.

Clinicians treated him for sepsis, incomplete bone development and the effects of oxygen deprivation. Banks is now six months old, active and healthy, and his owner plans to train him for barrel racing, a timed race around barrels.

What a red bag is

Normally the first thing to appear at birth is the whitish amnion, which contains the foal. In a red bag delivery the placenta separates from the wall of the womb too soon, and a red velvety membrane emerges first. While it stays intact, the foal stops getting oxygen from its mother but can't yet breathe on its own. That's why a red bag is treated as an emergency: every minute counts.

Why a red bag happens

Premature separation of the placenta is often linked to inflammation of the placenta (placentitis) and to other problems in pregnancy. Sometimes there are signs in advance: early udder development, leaking milk or vaginal discharge. If you notice these changes in an in-foal mare weeks before her due date, have her seen by a vet: an ultrasound can help assess the placenta, and timely treatment can prolong the pregnancy and reduce the risk of complications.

How the foal was saved in the first hours

The mare's owner, Dave Aguilar, had arranged in advance for his mare Sierra to foal at his regular vet's clinic. This was a precaution, even though Sierra had already delivered several healthy foals.

The vet immediately recognised the red bag and delivered the foal. He "stayed abnormally quiet and could not stand or nurse", so she referred him to the University of California straight away. According to the university, Aguilar trailered the mare, while the foal travelled on the back seat of his truck, held by his son. The drive took nearly three hours, and Banks reached the hospital within five hours of birth.

What the clinicians saw

Banks was admitted by large animal resident Hillary Bunay and vet Emily Berryhill. He was small, with a silky coat and curled ears, typical signs of prematurity. X-rays of his knees and hocks showed that the bones weren't yet fully mineralised, and tests pointed to sepsis.

Treatment in intensive care

Banks was given intravenous antibiotics and plasma to support his immunity, fed by tube and given oxygen. Clinicians monitored his nervous system, kidneys and gut, and paid especially close attention to his breathing, as the lungs of premature foals may not fully inflate.

His condition remained critical for several days, then began to improve. He moved from tube feeding to drinking milk from a pan, his organs began working normally and physiotherapy began. Follow-up X-rays nearly a month later showed good bone formation.

The change from a foal barely able to lift his head and unable to stand to a bouncing, bucking, and nursing baby brings everyone so much joy.

Emily Berryhill, chief of service, UC Davis School of Veterinary Medicine

Student volunteers and a mother next door

Student volunteers stayed with Banks around the clock. One of their jobs was an unusual one: keeping the foal from standing until his bones were strong enough to bear weight. Sierra lived in the adjoining stall the whole time, as the unit is designed to keep mare and foal together, and she let staff milk her regularly.

Why a premature foal mustn't stand too soon

In premature foals, the small bones of the knees and hocks are still mostly cartilage. If a foal starts standing and walking actively before they've strengthened, the bones can collapse and the joints can be deformed for life. So these foals have their movement restricted, sometimes wear splints and have regular X-rays to show when their workload can gradually be increased. That was exactly the job of the students on duty with Banks.

Sepsis in newborn foals

Sepsis, or blood poisoning, is one of the main causes of death in newborn foals. Bacteria can enter the body in the womb, through the navel or through the gut, especially if the foal hasn't had enough colostrum. Warning signs include lethargy, refusing to suckle, a high or low temperature, reddened gums, diarrhoea and swollen, hot joints. Sepsis develops within hours, so treatment starts right away, without waiting for all the test results.

Signs of a premature foal

Vets look for these signs:

• small size and low weight for the breed;
• a short, silky coat and soft, curled or drooping ears;
• weakness: the foal can't stand or suckle;
• a domed forehead and weak joints with lax ligaments;
• incomplete ossification of the knee and hock bones on X-ray.

The 1-2-3 rule

Many vets advise owners to remember a simple rule for a healthy newborn foal: it should stand within about an hour and suckle within about two hours, and the mare should pass the placenta within about three hours. If something isn't right, call your vet without waiting until morning.

Why colostrum and plasma matter so much

Foals are born without antibodies of their own and only get protection from their mother's colostrum in the first hours of life. If a foal is weak and doesn't suckle, it's left defenceless against infection, and sepsis develops very quickly in newborns. So vets check the antibody level in the blood and give plasma if needed, as they did with Banks.

How to prepare for foaling

1. Note the expected date and discuss a foaling plan with your vet.
2. Learn the signs of a red bag and other complications.
3. Prepare a clean place, such as a roomy stable with straw.
4. Keep to hand your vet's number, scissors, towels and a torch.
5. Plan your transport: how and where to take the mare and foal if you need a clinic.
6. If the mare has had complications or is high-risk, consider foaling at a clinic.

What to do in a red bag delivery

If you see a red velvety membrane instead of a whitish sac, call your vet immediately. Specialists advise carefully opening the membrane without waiting for the vet, so the foal can get air, and helping the delivery by gently pulling the foal's legs down towards the mare's hocks in time with her contractions. After the birth the foal must always be seen by a vet, even if it looks normal: the effects of oxygen deprivation can appear later.

The family decided to keep the foal

Dave Aguilar runs a small breeding operation that has produced about a dozen foals in 15 years. Banks's sire is a stallion whose offspring have earned more than $20 million in competition.

There was never a thought to selling him after what we've been through. There's just no way we're letting him go.

Dave Aguilar, the foal's owner

The mare needs a check too

After foaling, the vet examines the mare as well. It's important to make sure the whole placenta has come out: any left in the womb can cause inflammation, blood poisoning and laminitis, a severe condition of the hooves. The vet will also check for tears in the birth canal and whether the mare has milk. Keep the placenta in a clean bag until the vet arrives, as it shows whether it has separated completely and whether there are signs of infection, which is especially important after a red bag.

What barrel racing is

Barrel racing is a fast western riding discipline popular in the US, in which a rider races against the clock around three barrels set out in a triangle. It calls for fast, agile horses, most often American Quarter Horses. Banks won't start training for a long time yet: young horses are only gradually introduced to work once their bones and joints have fully developed.

What this means for Europe

Neonatal units for foals exist in Europe too, usually at university veterinary hospitals and large equine clinics. Banks's story shows that even very sick newborn foals can survive if everything is done quickly: recognising the complication, delivering the foal and getting it to specialists in time. Mare owners in any country should find out in advance where the nearest clinic that can take a newborn is, and how to get there.

When to see a vet

Call your vet right away if your mare has a red bag, if labour lasts longer than 20–30 minutes after her waters break, or if the foal is in the wrong position or doesn't appear. A foal also needs urgent attention if it doesn't stand within an hour or suckle within two hours, or if it's lethargic, breathing poorly or seems premature. If the placenta hasn't passed within three hours, this is another reason to call urgently.