This paper will examine treatment options and decision making in bovine dystocia management, within the context of a clinical case. The evaulation of the patient and diagnosis and treatment of uterine torsion will be discussed followed by a progression through treatment decisions. The decision of when an assisted vaginal delivery is an option and the point at which to pursue more aggressive treatment will be discussed followed by an investigation of situations in which C-section, fetotomy and shipping/euthanasia may be more favorable options. Supportive care and the importance of prevention will be addressed. It is the goal of this writing to stress the importance of a thorough physical exam, review the diagnosis and treatment options of uterine torsion and provide a framework for decision making in clinical cases of bovine dystocia.