Again you mentioned obviously we don’t want anyone to be in distress and safety of course is an issue so what might some of the common reasons be that a doctor would then recommend that a c-section is necessary sure this is a very good question number one is labor dystocia what that means is if the labor does not progress the way that we expect it to the textbook right so thankfully from that standpoint we are we’re being a little bit more liberal because we are working on this number of decreasing our c-section rate but that was a number a number one reason actually number two is abnormal or indeterminate fetal heart rate tracing like I mentioned sometimes seeing the heart rate is it’s a little off or different than what we expect can prompt a c-section another one is mal presentation which is the breech presentation or or transverse when the babies are side to side and then another one would be multiple gestation and then suspected macrosomia which is when we suspect that the baby is too large we use ultrasound to help us as a tool but it is actually about one one pound plus or minus from the actual delivery weight so it’s a bit difficult to make that kind of call ahead of time and sometimes we just have to make the call based on the numbers that we have and so that’s another reason why women end up with a c-section.