Caesarean section in the second stage of labour is a difficult procedure, with little published evidence to guide practice. We investigated the background and morbidity. Case notes of all emergency caesareans at full dilatation over 1 year in two hospitals were studied for demographics, grade of attending doctor, other methods of surgical delivery and morbidity. A total of 91 (15.3%) of 595 emergency caesareans were performed at full dilatation. Instrumental delivery was attempted in 36 (40%). A consultant was present in 29 (32%). In 16 (18%), the venous pH was <or= 7.2. In 52 (57%), maternal complications arose; the commonest were post-partum haemorrhage, sepsis and uterine tear. Seven (8%) babies were admitted to the neonatal unit. We found these procedures to carry a high maternal morbidity, but relatively low neonatal morbidity and recommend the most senior obstetricians should be involved with decision-making and delivery in these cases.