PIP: The purpose of this review is to describe the changing features of cesarean section in our community over the years, to relate the observed pattern to changes in maternal and perinatal mortality rates, and to compare our findings with those from other populations. A retrospective review of 2150 consecutive cesarean sections over 9 years between January, 1977-December, 1985 at the University of Ife Teaching Hospital, Nigeria showed an overall section rate of 6.7%. However, over the years, the rate increased from 2.3% in 1977 to 10.6% in 1985 due to a higher proportion of cephalopelvic disproportion (39.9%). Analysis of the 1400 retrievable casenotes revealed that 56.8% of the patients were aged between 21 and 30 years; 24.6% aged between 31 and 40 years; 16.1% aged 20 years and only 2.5% aged 40 years. Cesarean operation is most commonly performed in primigravida and grand multipara. Overall, 78.8% of the cesarean sections were performed as emergency procedures while 15.0% were elective procedures; 6.2% of the planned elective cesarean operation were later performed as emergencies. The operation was associated with high maternal morbidity and mortality. 33.3% were morbid cases; sepsis was the most common cause followed by anemia, postpartum hemorrhage, and puerperal psychosis. Although, maternal mortality in cesarean delivery (0.71%) was significantly higher when compared to vaginal delivery (0.58%), there was no correlation between increasing section rate and maternal mortality. Similarly, increasing section rate had no detectable effect on perinatal mortality during the period; the perinatal mortality rate associated with cesarean section was 6.14%. Possible factors influencing the increasing section rate include increased cephalopelvic disproportion cases resulting from malnourished mothers with contracted pelvis and high numbers of failed induction cases. Measures that would improve maternal and fetal prognosis in cesarean section in our hospital include improved antiseptic measures, availability of blood transfusion, good screening during antenatal visits, and early recourse to the operation when indicated.