Background: Over last decade progressive increase in the rate of deliveries by cesarean section, is a cause of major public health concern due to potential maternal and perinatal morbidity. The driving factor leading to steady increase in cesarean delivery is not completely understood and there is lack of consensus on the appropriate cesarean section rate. This study will present the cesarean section rate in primigravida at our institute, indications of cesarean section and associated maternal and fetal morbidity. Methods: This was a retrospective study done on primigravida who delivered by cesarean section in the department of Obstetrics and Gynecology, SMBT institute of medical sciences & research center during one-year period. Result: The incidence of cesarean section in primigravida in our study was 29.09%. Most common indication of cesarean section in primigravida was fetal distress 39.81%. Amongst 41 cases of cesarean sections done for fetal distress, 33 cases had spontaneous onset of labor, 5 cases were induced with pgE1. Other common indication of cesarean section was cephalopelvic disproportion in 12.62% of cases, oligohydramnios in 11.65% of cases and breech presentation in 9.71% of cases. Most common antenatal high-risk factor was hypertensive disorder of pregnancy in 18.44% of cases. Blood transfusion and postpartum hemorrhage were the maternal morbidities noted in our study. Common cause for NICU admission was respiratory distress syndrome. Conclusion: Standardization of indications of primary cesarean section at tertiary center level is required. So that sequential annual audit of cesarean sections can help to strategize improvement of antenatal care for the reduction of primary cesarean section rate.