Objective To understand the indications for and factors related to cesarean section (CS). Methods Pregnant women who attended health examination at three selected district hospitals were investigated from May 2001 to February 2003. Results Among 933 puerperas, the CS rate was 37.62%. The top four indications for CS were fetal distress (36.5%), social factors (35.9%), relative cephalopelvic dispro- portion (18.5%) and pregnancy complications (6.3%) respectively. The result of regression analysis showed that puerperas who were overweight before pregnancy, had no confidence in vaginal delivery and had macrosomia were more likely to have CS. Conclusion At present, the CS rate in Shanghai was rather high. The main indica- tions for CS were fetal distress and social factors. The high CS rate was associated with the psychological factor and some demographic factors such as birth weight and puerperas’ weight before pregnancy. Objective To understand the indications for and factors related to cesarean section (CS). Methods Pregnant women who attended health examination at three selected district hospitals were investigated from May 2001 to February 2003. Results Among 933 puerperas, the CS rate was 37.62%. The top four indications for CS were fetal distress (36.5%), social factors (35.9%), relative cephalopelvic dispro- portion (18.5%) and pregnancy complications (6.3%) respectively. The result of regression analysis showed that puerperas who were overweight before pregnancy, had no confidence in vaginal delivery and had macrosomia were more likely to have CS. Conclusion At present, the CS rate in Shanghai was rather high. The main indica- tions for CS were fetal distress and social factors. The high CS rate was associated with the psychological factor and some demographic factors such as birth weight and puerperas’ weight before pregnancy.