Back ground: Globally, the Caesarean Section (CS) rate is increasing. Evidence have shown CS rate above 10-15% does not improve maternal or new-born outcomes. Although the World Health Organization recommends to use the Robson Ten Group CS classification to assess, monitor, audit and compare CS rate since 2015, in Ethiopia, the system is not well implemented.

Objective: The aim of this study was to analyse CS rate using Ten-group Robson classification among women who gave birth at Hawassa University Hospital in Southern Ethiopia.

Methods: A prospective birth registristration was conducted between June 2018 and June 2019.  Medical birth registry was adapted from the Kilimanjaro Christian Medical Centre in Tanzania and was used to collect the data. All mothers who gave birth at Hawassa University Referral Hospital during one-year period were included in the study. Information regarding socio-demographic, obstetrics and Robson’s classification parameters (Parity, Onset of labour, Gestational age, Number of foetus, Foetal lie and presentation) were collected from the mother and mothers’ individual folders. Data were entered using EpiData 3.1 and analysed using SPSS version 25.0 software.

Results: A total of 4004 women gave birth during one-year period. The overall CS rate was 32.8% (95%CI: 31.4%, 34.3%). The major contributors to the overall CS rates were: Robson Group 1 (nulliparous without previous CS, single cephalic at term, in spontaneous labour) 22.9%; Group 5 (multiparous with at least one previous CS, single cephalic at term) 21.4%, and Group 3 (multiparous without previous CS, single cephalic at term, in spontaneous labour) 17.3%. The most commonly reported indications for CS were “foetal compromise” (35.3%) followed by previous CS (20.3%) and obstructed labour (10.7%).