Background:The most common obstetric surgery performed nowadays is a cesarean section (CS). Even though cesarean delivery is the safest mode of delivery in high-risk scenarios, it also appears to have a higher risk of maternal and newborn morbidity and mortality than vaginal delivery, and in low-resource settings, the risks are doubled. In this study we investigated fetal and maternal outcomes following CS in southern Ethiopia, specifically in the Gurage region, to better understand and quantify the prevalence of these outcomes and to provide recommendations based on the findings. Methods: Institutional based retrospective cross-sectional study was conducted in Gurage Zone in 5 governmental hospitals from February 21, 2021 to March 13, 2021, on the hospital medical records of mothers who delivered by CS from February 2019 to January 2021. The collected data was entered and analyzed using STATA version 15. Binary and Multiple Logistic regressions were used to identify associated factors for maternal outcome and fetal outcome. Results: Among the 368 mothers included in the study, 86 (23.4%) had poor maternal outcomes, and the 3 most common causes were postop infection 19 (25.6%), the need for blood transfusion 16 (21.6%), and anesthesia-related complications 9 (12.1%). On the other hand, from the 384 neonates studied, 75 (19.74%) had poor outcomes with 16 (4.2%) perinatal death, and 60 (15,6%) had low first-minute APGAR scores needing close monitoring. Obstetric complications, medical diseases, and AntePartum Hemorrhage as an indication for CS were statistically significant factors for poor maternal outcomes. Similarly, medical disease and cephalic pelvic disproportion as an indication for CS were statistically significant factors for poor fetal outcomes. Conclusion and recommendation:The numbers are not uniformly high or low when compared with other regions of Ethiopia, but they are closely related, suggesting a need for immediate collaborative evidence-based interventions to improve hospital capacities and preoperative optimization strategies, since pregnancy-related complications, preoperative hemorrhages, and preoperative medical conditions all contributed to poor maternal and neonatal outcomes.