A call was made to Cornell’s Ambulatory Service for dystocia of a multiparous Holstein. The cow had already given birth to one live bull calf, but farm employees had noticed additional signs of labor. Upon presentation, the cow was standing and bright, alert, and responsive. On vaginal examination, an additional calf was palpated. Presentation of the calf was anterior, position dorso-pubic, and posture was a flexed neck laterally to the dam’s left and a flexed right leg with elbow extension. Manual traction was placed on the calf’s neck in an attempt to correct the posture while external pressure was placed on the cow’s left side. However, no progress was made and the decision to perform a Cesarean section was elected. The cow was clipped and aseptically prepped for a standing left flank approach. The cow was locally anesthetized using a distal paravertebral block in addition to a line block just caudal to the last rib, and then aseptically prepped again for surgery. A sharp incision was made through the skin, subcutaneous tissues, muscles, and peritoneum into the abdominal cavity. The front right leg of the calf was palpated through the uterine wall and elevated into the surgical site to lock the uterus in place. The uterus was sharply incised and a live heifer calf was pulled out of the uterus. The uterus was closed with a simple continuous pattern with a Utrecht oversew. During this time, the cow dropped into sternal recumbency; the uterus was elevated to prevent contamination of the surgical field as the uterus was being closed. The abdomen was closed, and no other complications were encountered. The cow was placed on the farm’s post-op treatment protocol of Polyflex (ampicillin) and Meloxicam for 5 days. This report will describe the surgical procedure of a typical Cesarean section in dairy cattle and the economic decision tree analyses for Cesarean sections in dystocia cases.