The most common indication for equine caesarean section is dystocia (difficulty during foaling) and decision-making at the time of first indication of difficulty must be rapid for the best chance of saving the mare and retrieving a live foal.
For the mare, results are now good with efficient and expert caesarean section, if admitted early in the course of the dystocia. For the foal, results are also now good with expert neonatal intensive care if it is alive at surgical delivery, if it is 'ready for birth' (in terms of dates and maturity) and if the mare is admitted early in the course of the dystocia.
The mare is assessed as to whether the foetus (unborn foal) is alive, whether the dystocia is the result of mal-presentation or foetal oversize, or whether there is another reason for the problem. Elective caesarean sections are carried out less frequently, but may be indicated for a variety of reasons. In order for the foal to have a good chance of survival it must be 'ready for birth'.
In some cases, hoisting the mare's hindquarters then allows the foetus to be repositioned and delivered per vaginam (through the cervix and vagina). This is called a controlled delivery which, if achievable, relieves the need for a caesarean section. In other cases, the foetus still cannot be repositioned for vaginal delivery and the mare is then transferred to the operating theatre for Caesarean section, without delay.