Caesarean section delivery (CD) is the most common surgical operation performed in the world. Since first described 400 years ago, surgical rates continue to rise globally. Caesarean rates are now reported from South American countries to rates of over 50% and rates of over 32% are currently being reported from the United States, China, England and Scotland. Surgical complications can occur at the time of operation and there are major implications for future pregnancies, including increased rates of placenta previa/accreta, stillbirth and preterm labour. This Element discusses many aspects of CD, including the Robson 10 group classification system, which classifies populations by characteristics such as parity, presentation of the fetus and the history of previous births, an evidence-based approach to surgical techniques, recommendations of the major guidelines and recommendations concerning trial of labour after previous caesarean.