Objective: To analyse rising rates of caesarean section, its indications and effect on maternal and neonatal outcomes viz a viz vaginal deliveries with special focus on primary caesarean section. Study design: This was a prospective observational study of 1000 deliveries after 28 weeks’ gestation. The different modes of deliveries were studied with respect to their antepartum, intrapartum and postpartum feto-maternal outcomes. A comparative analysis of caesarean and vaginal deliveries was carried out with particular focus on primary caesarean sections. Results: The caesarean section rate was 47.1% out of which 66.2% were primary caesarean sections(PCS). The most common indication of PCS was found to be foetal distress (34.2%) and blood loss, febrile morbidity, SSI were more in caesarean sections compared to vaginal deliveries (VD). Neonatal outcomes too were relatively worse in caesarean sections compared to VD. Conclusion: There has been an unacceptably high rise in caesarean section rates globally. It has been accepted that maternal and neonatal outcomes remain comparatively favourable with vaginal deliveries. Hence there is a need to have a closer look at the various indications of caesarean deliveries with regular caesarean audits at all levels of health care with a targeted focus on PCS, which is the genesis of the rising rates. CS should be resorted to only when there is an evidence based indication with the aim of improving the reproductive years of the mother and future development of the newborn..