Background: The Primary caesarean section (CS) delivery rate is increasing due to public interest to avoid fetal complications and acceptance by most of the couple to complete their family with one or two children. High cesarean birth rates are an issue of international public health concern. Worries over such increases have led the World Health Organization to advise that Cesarean Section (CS) rates should not be more than 15%, with some evidence that CS rates above 15% are not associated with additional reduction in maternal and neonatal mortality and morbidity. Aims and Objectives: To find out the indications of caesarean section among primigravida in a tertiary care centre. Methods: A total of 100 cases were selected for the study who regularly attended outdoor (Booked) and admitted, those who booked in antenatal clinic but admitted as emergency. Results: The most common age group in the present study was 20-25 years (45%). Among the study cases, 80% were booked, 20 % were unbooked. Conclusion: Obstetric factors occurring around birth, including obstructed labor and fetal distress were the main reasons leading to Cesarean Section rather than background characteristics assumed to be a risk. The results imply that there is a need for timely and accurate screening of women during obstetric care and, decision to perform cesarean section should be based on clear, compelling and wellsupported justifications .Early referral instead of late referral from the periphery hospitals to the tertiary hospital is necessary for trial of vaginal delivery.