Background: Maternal age at delivery and cesarean section rates are increasing. In older women, the decision on delivery mode may be influenced by a reported increased risk of surgical interventions during labor and complications with increasing maternal age. The purpose of this study was to determine the Incidence of Cesarean Section in elderly gravida which would help us subsequently, in delineating the management of elderly gravid. Material and Methods: This prospective study was carried out in The Department of Obstetrics and Gynaecology at Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla for one year period from 1st July 2018 to 30th June 2019. All participants were divided into two groups Group 1 (Study Group) had consisted of all pregnant women with age 35 years or more. While Group 2(Control Group) consisted of every pregnant woman with age ≥20 to ˂35 years, who gets enrolled in the labor room admission register next to a case, was taken as a control. Comparative data of the two groups was subjected to statistical analysis. Results: There were 6922 deliveries out of which 415 subjects were >35 years of age, the incidence was 6.00%. Maximum number of subjects (84.10%) were in the age between 35-39 years. In the Study Group out of 415 subjects, 87 had early pregnancy loss. Out of remaining 328 subjects, 28.96% landed in caesarean section. 16.16% had emergency LSCS, while 12.80% had elective LSCS. In Control Group out of 415 subjects, 21 had early pregnancy loss. Out of remaining 394 subjects, 16.75% had caesarean section. 14.47% had emergency LSCS and 2.28% had elective LSCS. The common reasons for CS in study groups were Acute fetal distress, Breech, First twin breech, APH (Placenta praevia/ abruption), Previous LSCS with poor Bishop score & IUGR while in control groups reasons were Acute fetal distress, Breech, APH (Placenta praevia/ abruption), Failure of induction & Non-progress of labor. Conclusion: We found an increase in operative deliveries with increasing maternal age. The common reasons for CS were Acute fetal distress, Breech, First twin breech, APH, Previous LSCS with poor Bishop score, IUGR, Failure of induction & Non-progress of labor.