BACKGROUND This study was done to evaluate the changing trends in caesarean section over one-decade period and to determine as to whether increase in caesarean section rate is due to increase in antenatal surveillance or due to medically complicated pregnancies. MATERIALS AND METHODS The study was conducted in a 150 bedded government hospital, a maternity hospital affiliated to Andhra Medical Collage, Visakhapatnam, Andhra Pradesh. Data was collected retrospectively from database from 2008 to 2018. The CS rates and indications of primary and repeat caesarean sections (CS) were analysed among 6478 live births during 2018. CS rates have increased as it has become the procedure of choice in high risk pregnancies to prevent prenatal morbidity and mortality; this has become possible due to improved patient care, availability of effective antibiotics, blood transfusion services, safer anaesthesia, improved surgical technique and sophisticated neonatal care services. RESULTS As medically complicated pregnancies and antenatal surveillance have increased, there was an increase in caesarean section rate. Caesarean section rate increased from 21.88% in 2008 to 38.91% in 2018. There was an increase in primary section and repeat sections. Primary caesarean section rate was 57.67% compared to repeat caesarean section rate which was 42.33%. This increase in caesarean section rate is due to increase in indications like cephalo pelvic disproportion and pregnancy being associated with medical disorders (PIH, GDM, hypothyroidism). CONCLUSION Rising risk of caesarean section over one decade is attributed to increased antenatal surveillance, identification of High Risk pregnancies and frequent resort to elective sections in high risk situations.