This paper examines the impact of near birth complications and socio-demographic, healthcare and spatial characteristics of caesarean section in Egypt, using data on 4032 births from the 2000 Egypt Demographic and Health Survey. The hospital caesarean section rate was 22% in Egypt. Fever/vaginal discharge around delivery, birth weight, mother’s age and education, birth order, residence and antenatal visits were important determinants of caesarean section. Variations by place of delivery were evident, although complications were more significant determinants of caesarean section in public settings and demographic characteristics were more important in private facilities. Unexpectedly, long labour and bleeding around delivery were not associated with caesarean section, particularly, in private hospitals. In view of the high and rising caesarean section rate in Egypt, monitoring the quality of maternity services in Egypt is imperative. An investigation of the forces sustaining the differential in determinants by place of delivery is needed.