Introduction: Cesarean section (CS) was introduced in clinical practice as a life saving procedure both for the mother and the baby. The rising rate of Caesarean sections has been a concern for over two decades. Bearing in mind that in 1985 the World Health Organization (WHO) stated: “There is no justification for any region to have CS rates higher than 10-15%”. Data indicate that the maternal mortality rate associated with caesarean delivery is 3-7 times greater than that associated with vaginal delivery. The overall mortality rate from cesarean delivery alone is 6 per 100,000 procedures. There are many potential intraoperative and postoperative complications associated with cesarean delivery for the mother and the fetus. If the cesarean delivery rate continues to remain high, institutions must be prepared to manage the potential complication of severe hemorrhage associated with higher rates of placenta accreta. Current research on pelvic floor injury from vaginal delivery does not offer sufficient evidence to mandate a change in standard clinical management of labor and birth towards CS. Numerous factors as medical and nonmedical ones affect rates of CS, which may provide ways to decrease the cesarean delivery rate. So the aim of our work is to provide best practice to the management of pregnancy, labour and delivery that will achieve a Caesarean section rate consistently below 20% and will have aspirations to reduce that rate to 15% according to the WHO. This should have an impact on admissions to neonatal units, adverse incidents, health outcomes for mothers in this and future pregnancies, successful breastfeeding, hospital stay, birth experience and productivity (cost savings). Aim: To show the impact of cesarean section on mother and fetus and to review the indications and strategies for cesarean section reduction. Methods and Analysis: The 2008 EDHS obtained information on the frequency of caesarean sections in Egypt showed that more than one-quarter of deliveries in the fiveyear period before the 2008 EDHS survey were by caesarean section. The EDHS survey in 2014 revealed that 52% of deliveries in Egypt were by CS. Our hospital data showed that Vaginal delivery in the first six months of year 2014 occurred in 45.3% of women with 63% in multipara and 37% in primigravida versus CS delivery in 54.7% of women with 33% in primigravida and 67% in patients with previous CS. Nearly 50 % of primigravida delivered by CS in El-shatby Maternity Hospital. Less than 2% underwent VBAC. Statistics in ElShatby maternity university hospital, a tertiary care center in Alexandria (250 beds) showed that cesarean section represented 60.7% (5376 of 8846) of all deliveries in 2012, 58.4% (5799 of 9929) in 2013 and 53.5% (5475 of 11779) of all deliveries in 2014. Conclusions: The indications for CS have been clinical factors for years, such as previous CS, dystocia, fetal distress, breech presentation, and mal presentation. Recent temporal trends in maternal characteristics that might help explain rising CS rates include increasing maternal age and higher rates of hypertension, diabetes, obesity, and multiple gestations. However, many other factors have contributed to the increasing rate of CS in recent years, including improved surgical techniques, providers and patient’s perception of the safety of the procedure, patient demand, physician non acceptance of guidelines, money earning and pressures on caregivers to practice “defensive medicine.” The strategies should include the following: The Robson 10-group Caesarean section classification system is a simple, standard tool to identify groups making the most significant contribution to the overall rate of CS, so we can work upon it. Review nurses responsibilities and student nurse training with incorporation in doula or midwifery programs. Reduction in the total cesarean delivery rate would require a reduction in the primary caesarean delivery rate and recurrent CS with implementations of the guidelines of normal labour and vaginal birth after CS (VBAC).