Science & Resources
Transition to Consciousness at Birth:
Comparative Analysis of Equines and Humans
The transition from fetal life to consciousness at birth involves complex biological processes. My research explores this process in both horses (newborn foals) and human infants, examining similarities and species-specific differences that influence survival and developmental outcomes. In utero, equine and human fetuses exist in a sleep-like state in which the brain is an inhibited cortical state. They cannot be aroused by stimuli that would normally do so after birth. Likewise, the physiology of the foal and infant in utero relies on the placenta and the in-utero environment for things like oxygenation, thermoregulation, nutrition, and suppression of autonomic function. At birth, he must change for survival, and we refer to this process as a transition of consciousness at birth.
Our UC Davis School of Veterinary Medicine team discovered the cause of the condition known as Neonatal Maladjustment Syndrome or dummy foal, which is commonly associated with the persistence of the hormones, called neurosteroids, that keep the foal asleep in the womb. Rule #1 is No Galloping in utero! But, the foal is a prey animal and a precocious species, meaning it has advanced capabilities immediately post-birth, rapid onset of consciousness and perception, and the ability to move, run, and stick close to its dam (mother), and nurse within an hour or two of birth. This requires a significant and rapid transition in consciousness and physiology. The newborn foal and infant can no longer rely on the placenta and the inutero environment for oxygen, thermoregulation, energy, and more.
In the infant, this transition or switch must also occur at birth. However, there are some differences. The infant is altricial, meaning they are born in a relatively immature state. At birth, human babies have limited motor abilities, requiring extensive postnatal care, nourishment, and social support for survival. Their brains are highly plastic, allowing extended neural development and learning after birth. Unlike foals, who experience quick transitions to facilitate wakefulness, human infants gradually transition to consciousness. Human infants benefit from prolonged postnatal care that fosters brain growth, adaptability, and cognitive complexity. However, for these long-term neurodevelopment processes to proceed as evolutionary biology intended, the infant must receive the signals to transition from the altered consciousness and physiology in the womb.
Our work suggests that a failure to transition consciousness and physiological functions at birth may compromise foal and infant survival and complicate critical care. Factors such as hypoxia and birth delivery conditions may affect the transition of consciousness and stimulate neuroprotective mechanisms, further altering behavior.
The above is a very brief summary. The science associated with these concepts is found in many papers in the scientific literature. I have decided to put this together in book form - Awakening at Birth.
Exploring Endocrine, Neurodevelopmental, and Behavioral Chages
Observations, Science and Resources
Awakening at Birth is a scientific detective story about how a mystery involving newborn foals led to a new way of thinking about birth, consciousness, and neurodevelopment across mammalian species—including humans.
The story began with newborn foals who appeared physically healthy yet behaved as though they had not fully awakened. They did not recognize their mothers, could not nurse, and seemed disconnected from their surroundings. Many of the foals referred to our NICU were known among horse breeders as "dummy foals"—a long-standing but unfortunate term used in the horse world.
Their unexpected recovery challenged the long-held belief that their condition was primarily caused by a significant low-oxygen (hypoxic) brain injury.
These clinical clues led our research team at the University of California, Davis, to investigate a broader biological question: How does the brain transition from the protected state of fetal life to the alert, responsive state required after birth?
The book follows that investigation—from the maladjusted foal and the development of the Madigan Squeeze Procedure to emerging questions about how birth canal pressure signals the brain, maternal contact, kangaroo mother care, and their possible effects on long-term neurodevelopment. It explores how discoveries in animals may illuminate human medicine through the One Health Principle. Clinical studies in infants conducted with Stanford University Medical School based on research findings in newborn foals at the UC Davis School of Veterinary Medicine revealed new information about natural birth, cesarean birth and the power of the mothers skin to skin swaddling post birth.
Publications from our discoveries about birth
The "Madigan Squeeze" & Neonatal Maladjustment
Survey of veterinarians using a physical compression procedure in the management of neonatal maladjustment syndrome in foals. Animals 2017, 7, 69.
Aleman, M.; Kalie, M.; Weich, K.M.; Madigan, J.E. This study revealed maladjusted foals will awakening and nurse the mare much sooner than conventional veterinary treatment
Evaluation of Squeeze-Induced Somnolence in Neonatal Foals: Tóth B, Aleman M, Brosnan RJ, et al. Evaluation of squeeze-induced somnolence in neonatal foals. Am J Vet Res. 2012;73(12):1881-1889. The foundational study exploring how thoracic pressure could mimic the birth canal to change the brain.
Allopregnanolone infusion induced neurobehavioural alterations in a neonatal foal: is this a clue to the pathogenesis of neonatal maladjustment syndrome? Equine Vet J Suppl. 2012 Feb;(41):109-12. Madigan JE, Haggett EF, Pickles KJ, Research proving that "dummy foal" symptoms can be chemically induced in healthy foals by infusing neurosteroids.
The Human Connection: "Barn to Bedside"
Skin-to-skin contact after birth and the natural course of neurosteroid levels in healthy term newborns. McCallie KR, Gaikwad NW, Castillo Cuadrado ME, Aleman M, Madigan JE, Stevenson DK, Bhutani VK. J Perinatol. 2017 May;37(5):591-595. doi: 10.1038/jp.2016.268. A wonderful collaboration with Stanford Medical School showing that infants born by vaginal delivery vs cesarean delivery have different hormonal transitions at birth and that skin to skin care is helpful to transition to the chemistry of wakefulness.
Potential benefit of a thoracic squeeze technique in two newborn calves delivered by caesarean section. N Z Vet J. 2020;68(1):65-68. Stilwell G, Mellor DJ, Holdsworth SE Evidence that physical signals can replace the mechanical stimulus missing in surgical deliveries—a concept directly applicable to human obstetrics.
Resuscitation compression for newborn sheep. Vet Clin North Am Food Anim Pract. 2021;37(1):175-181. Flora T, Smallman M, Kutzler MA. Controlled study in lambs showing significant improvement in low vigor newborn lambs.
Clinical Resources for Veterinarians
Manual of Equine Neonatal Medicine, Revised 4th Edition: Dr. Madigan’s seminal text, now in its latest edition, serving as the "gold standard" for neonatal foal care. https://www.equineneonatalmanual.com/
Neonatal Maladjustment Syndrome in Calves. Stilwell G, Madigan J. In: Simões J, ed. Encyclopedia of Livestock Medicine for Large Animal and Poultry Production. Springer, Cham; 2025.