Not all caesarean sections are alike in that some may pose more technical challenges than others. This is never truer than for the second stage caesarean sections. Efforts must be made to allow as many women as possible who reach the second stage to deliver vaginally. Delayed pushing and manual rotation are interventions which may help. Identifying the round ligaments ensures the uterine incision is central and may prevent damage to the uterine vessels. To facilitate access to the fetus, an adequate incision is essential. Incisions which are too low may be inadvertently made in the vagina. Tocolysis has been used to facilitate delivery of the fetal head as has pressure from below by an assistant. Digital pressure applied per vaginum may cause fetal damage. The risk of fetal intracranial haemorrhage is not reduced by caesarean section as compared to operative vaginal delivery. In this respect, maintaining skills for forceps and vacuum-assisted deliveries is important.