Introduction: Rapidly increased global prevalence of overweight and obesity has also affected women of reproductive age group. Pregnant women who are obese at booking have an increased risk for complications, both for themselves and their babies during pregnancy and childbirth. Women who are obese are at risk for gestational diabetes, miscarriage, preeclampsia, increased incidence of cesarean section, anesthetic complication, postpartum hemorrhage, thromboembolism, perineal trauma, and wound infection. There is an increased risk of stillbirth, congenital anomalies, prematurity, macrosomia, poor APGAR scores, and neonatal death in babies of obese mothers. This study investigated the effect of Maternal BMI on the mode of delivery and perinatal outcome. Methods: This is a prospective cohort study of 100 primigravidas of the reproductive age group done at Shivpuri District Hospital over a period of a year. We categorized them on the basis of their BMI at booking and studied the mode of delivery and perinatal outcome. Results: Elective cesarean and emergency cesarean were more common with obese women whereas most of the normal weighted and underweight women underwent spontaneous labor and induced labor. Maternal and fetal complications were more pronounced in the overweight and obese groups. Babies also had an increased risk of poor APGAR scores with the increasing BMI of the mother. Conclusion: Input of skilled birth attendants is essential to improve intrapartum outcomes. Obstetricians need to be acutely aware that obese patients form a high-risk population with an increased incidence of cesarean section, postpartum hemorrhage, and perineal trauma.