This chapter explains the indications for the Caesarean section organised into four categories. In principle, the considerations are that the decision to delivery time for category 1, where immediate threat to life of women or fetus, should be less than 30 minutes and mother's safety is paramount. The majority of deliveries are achieved through a low transverse abdominal skin incision and a transverse incision through the lower segment of the uterus. The chapter discusses the maternal or fetal compromise, the necessity of early delivery, and elective Caesarean section, explaining their ractical surgical steps, complications, and Caesarean hysterectomy. Instrumental delivery can be achieved through the use of vacuum extractor and forceps. Obstetricians should remain familiar with the technique of assisted vaginal breech delivery, as some patients will present with breech presentation in preterm labour or in advanced labour. Twin pregnancies have a higher incidence of pre-term labour, IUGR and preeclampsia.