Background: Caesarean section (CS) rates have been increasing globally, leading to concerns about the indications and contributing factors driving this trend. This retrospective study aims to identify the primary indications and contributing factors leading to CS at a tertiary care hospital in Ghailadh Village Madhepura, Bihar. Materials and Methods: A retrospective analysis was conducted on medical records of 50 women who underwent CS between November 2021 and July 2023 at a tertiary care hospital in Ghailadh Village Madhepura, Bihar. Data were collected on demographic details, obstetric history, indications for CS, and contributing factors. Statistical analysis was performed to identify the most common indications and associated factors. Results: The study included 50 women with a mean age of 28.3 years (SD ± 4.5). The primary indications for CS were fetal distress (30%), failure to progress in labor (25%), previous CS (20%), breech presentation (15%), and maternal request (10%). Contributing factors identified included advanced maternal age, obesity, and comorbidities such as hypertension and diabetes. The majority of CS was performed during the first and second stages of labor. Conclusion: Fetal distress, failure to progress, and previous CS were the leading indications for caesarean sections in this study. Contributing factors such as advanced maternal age, obesity, and comorbid conditions played a significant role. Strategies to manage these risk factors and appropriate counseling for expectant mothers could help in reducing unnecessary CS rates.