Background: One of the commonest surgery performed worldwide is caesarean Section (CS). The World Health Organization (WHO) has recommended an ideal caesarean section (CS) rate as 10-15%. In recent times the proportion of delivery conducted by caesarean section has increased.In this view we have started our study to analyse the primary caesarean section rate in a tertiary care centre at MGMGH, Trichy, Tamil Nadu, India Methods: This is a retrospective study of all the caesarean deliveries performed between 1st January 2018 to 30 th Novemer 2018 in the Department of Obstetrics and Gynaecology in Govt K.A.P.V Medical College, MGMGH, Trichy, Tamil Nadu, India. The caesarean rate was calculated as: (total number of primary caesarean deliveries/ total number of deliveries) × 100. The indications for primary CS included foetal distress, failed induction of labour, failed progression of labour, cephalopelvic disproportion, nonreactive CTG, other obstetric and foetal indications. Results: During the study period a total number of deliveries were 8184. 3759 patients had undergone CS with the CS rate being around 45.93%. Primary caesarean section rate is 22.45%. Majority of the primary caesarean section (90.53%) were performed as emergency procedure. Elective primary caesarean section rate 9.47%.Maximum number of patients were between 21-25 years (55%) and 79.65% were primipara. Cephalopelvic disproportion (36%) was the commonest indication followed by Non-reactive CTG (21%), fetal distress (20.5%). Conclusions: The rate of caesarean section is increasing with time. As primary caesarean section usually determines the lady’s future obstetric course, it is of prime importance to give effort for safe reduction of primary caesarean section. Individualization of the indication and careful evaluation, following standardized guidelines and practice of evidenced-based obstetrics followed by audits in the institution, can help us to limit the caesarean rates.