Background: Caesarean section (CS) is a major obstetric surgery done for pregnant women and is lifesaving. Aim: The study was aimed at reviewing CS at the Rivers State University Teaching Hospital (RSUTH), to determine the prevalence, trend and indications, for improved management outcomes. Methods: In this cross-sectional study, we reviewed five thousand, five hundred and ninety-eight (5598) cases of caesarean sections (3699 emergency, 1899 planned) managed at the RSUTH from 1st January, 2015 to 31st December, 2019. Data collected were analysed using IBM, Statistical Product and Service Solutions (SPSS), version 25.0 Armonk, New York. Results: There were 13,516 deliveries and 5,598 cases of CS over the review period, giving the prevalence of CS as 41.4% or 414 per 1000 deliveries. Emergency and planned CS cases accounted for 66.1% and 33.9% respectively. An increasing trend of CS was observed over the review period. The mean age ± SD of the participants was 32.30±1.04 years (95% CI:30.26,34.34). Modal age group was 35-39 years, accounting for 33.2% followed by those aged 30-34 years (26.2%). Majority of the patients were multipara [3396 (60.7%)], married [4890 (87.4%)], Christians [5540 (99%)] and had tertiary level education [2800 (50%)]. The commonest indication for CS in RSUTH was previous caesarean section [1925(34%)], followed by cephalopelvic disproportion [757(13.4%)], foetal distress [418(7.4%)], preeclampsia [390(6.9%)] and multiple gestation [252 (4.5%)]. Conclusion: The rate of caesarean section is high in RSUTH with an increasing trend. Although CS is lifesaving, efforts should be made to reduce the rate to the level recommended by WHO, especially in Low-middle-income countries (LMICs), where there is high aversion to CS.