Cesarean section is the delivery of a baby through a surgical incision in the mother’s abdomen and uterus. In certain circumstances, a c-section is scheduled in advance or done to prevent certain unforeseen complications.Normally it’s much more comfortable to deliver through natural ways than having cesarean section. This is because a cesarean section (C-section) is a major abdominal surgery and it carries more risks than normal or vaginal delivery.Mothers who deliver by c-section are more likely to have an infection, excessive bleeding, blood clots, more postpartum pain, a longer hospital stay, and significantly longer recovery than mothers who have normal deliveries.Sometimes injuries to the bladder or even bowels are common with cesarean section but are very rare with vaginal deliveries.However there are factors or circumstances that force medics or health experts to choose Cesarean delivery. Under such circumstances, the c-section is necessary for the well-being of the mother, the baby, or for both.Before a c-section is done, it is always important for the doctor and his client to have a common consent on this act. The doctor should inform his client on recommendations for this act.The client should fully understand the possible outcome of the cesarean delivery.Some mothers prefer or choose to go for cesarean delivery for fear of painful labor contractions. An elective C-section is the one that has no underlying clinical or pathological condition, and is always planned in advance.There are also conditions or situations that force medics to go for C-section in order to save the mother and her baby. Some of the factors that might prompt a c-section are linked to the fetus or unborn baby whereas others are linked to the mother’s health.The fetus or expectant baby’s heart may give health experts a cause for concern and continued labour procedures can harm the baby’s life.    Sometimes the umbilical cord of the fetus slips through the cervix (a prolapsed cord). If that happens, the baby needs to be delivered immediately because a prolapsed cord can cut off its oxygen supply.There are situations where the placenta starts to separate from the uterine wall (placental abruption), which means the baby will not get enough oxygen unless it is delivered immediately.Some babies might be large and for mothers with low cervix width it becomes difficult to deliver normally. The condition where babies are expected to be very large is known as macrosomia. The disease that can result in the increase of baby’s weight abnormally is diabetes.The unborn baby can be found to lie in an abnormal position that will not enable it to be delivered normally. The baby can be in a breech (bottom first) or transverse (sideways) position. However there are rare situations such as in twin pregnancy where the first baby is head down but the second baby is in breech position. In this situation the breech baby can be delivered vaginally. In addition, an unborn baby might have a malformation that would make a vaginal birth risky, such as some cases of open neural tube defects.For some mothers, the cervix stops dilating or the baby stops moving down the birth canal. In this situation, the mother attempts to stimulate contractions to get things moving again but fails. The only immediate solution for this is to have a c-section.Someone might have had a previous cesarean section with a classical or vertical uterine incision and sometimes could be more than one previous cesarean section. Such situations significantly increase the risk of the uterus rupture during contractions for vaginal delivery and it is a major indication for C-section.Also, a mother could be carrying more than one baby. Some twins can be delivered vaginally, but generally higher order multiple twins require cesarean delivery.A mother could have an obstruction in her uterus such as a large fibroid that would make a vaginal delivery difficult or impossible. This will force medics to go for c-section delivery.Some infections, such the herpes viral infection or exposure to HIV with high viral load, are major indications also call for cesarean delivery.The author is a doctor at the Rwanda Military Hospital – Kanombe.