The most common indication for equine caesarean section is dystocia (difficulty during foaling) and rapid decision-making at the first indication of difficulty is required for the best chance of saving the mare and retrieving a live foal. The mare is assessed as to whether the unborn foal is alive and to determine the cause of the dystocia. The vast majority of cases are caused by the foal being in the wrong position for birth. In some instances this can be corrected with the mare standing, but sometimes the mare may need to be anaesthetised for either a controlled delivery or caesarean section.
For the mare, results are good with efficient and expert caesarean section, if admitted to the hospital early in the course of the dystocia. For the foal, results are also 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.
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 foal to be repositioned and delivered 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 foal still cannot be repositioned for vaginal delivery and the mare is then transferred to the operating theatre for Caesarean section, without delay.