Background: Caesarean section (C-section) delivery has well established risks and adverse consequences. Every health care sector should look into the standards of maternal services it is providing. This audit look into the standards we have been providing at KRIMS Karwar with a comparison to national standards.Methods: This is a retrospective audit conducted by obstetrics and anaesthesia departments at KRIMS Karwar, Karnataka. Objectives were to look into incidence of C-sections, kind of anaesthesia used and maternal mortality. In addition, to look into any change in the obstetric care/outcome after Karwar district general hospital upgraded to a medical college teaching hospital. WHO guidelines for obstetrics care were set as standards. Retrospective data for the period between January 2007 and December 2018 has been collected and analysed.Results: Total number of pregnant women admitted for labour was 13431 with an average of 1221 per year. Proportion of caesarean delivery per hundred labouring women was 16.8 % in 2007 with significant increase to reach 51% in 2012. This has decreased in subsequent years to reach 23.5 in 2018. 99.9% of the C-sections have been done under spinal anaesthesia. There was one death of the mother subjected for C-sections in 2009.Conclusions: Incidence of C-sections was alarmingly high. Implementation of the uniform protocol has significantly reduced the C-sections rate. This reduction could be attributed to the upgrading the Karwar district hospital to a medical college teaching hospital. Protocol based practice will be continued and measures to improve overall maternity services will be implemented as per the WHO guidelines.