Objective: To examine the indications and rate of cesarean section in referral hospitals. Methods: Between January 2003 and December 2005, a total of 11,506 women delivered at King Hussein Medical Center, of which 2,075 cesarean sections (CS) were performed. Patients who underwent cesarean section were divided into three age sub­groups: <25 yr (n = 3,118), 25-35 (n = 6,147), and >35 yr (n = 2,241), and two parity subgroups-primiparous (n = 3,326) and multiparous (n = 8,180). Information abstracted included maternal characteristics and indications for CS. Statistical analyses were performed using the Pearson chi-square test and Fisher's exact test to evaluate differences between the various subgroups. Results: From a total of 11,506 deliveries that took place, 2,075 cesarean sections were performed with an incidence of 18% According to age, the CS rate was 11.85%, 20.5% and 19.9%, respectively, in the three age subgroups. According to parity, the CS rate was 16.3% and 18.7% in the primiparous and multiparous women, respectively. When matched to age, the indications for CS showed no significant difference among the three age subgroups. When matched to parity, the indications also showed no signifi­cant difference between the two parity subgroups except for dystocia which was significantly higher in the primiparous compared to multiparous women (p < 0.01), and for repeated CS which was significantly higher in the multiparous compared to primiparous women (p < 0.0001). Conclusion: Some indications for cesarean section such as dystocia and fetal distress were over-utilized resulting in a high CS rate. Proper management of labor and precise interpretation of fetal heart tracing might be effective in reducing the cesarean section rate.