Objectives: Alarming increases in cesarean section rates have been documented worldwide. The purpose of this study was to measure the cesarean section rate in Al–Khobar maternity care units and the frequency of influencing factors.

Methods: This retrospective cross–sectional study was conducted on women who had a cesarean section in maternity care units in Al–Khobar from July 2014 to July 2015. A total of 300 medical records were randomly selected with equal allocations from each maternity unit. Data were collected from medical records using a data collection sheet.

Results: The cesarean section rate was 31.9%. Half (50.01%) of the procedures were emergency cesarean sections, whereas 49.98% were elective procedures. Most cesarean sections occurred in private hospitals (91.35%), whereas 8.65% occurred in public hospitals.

Conclusion: More than one–third of the deliveries were cesarean sections. Emergency indications were more common in governmental hospitals than in private hospitals.