Introduction: Cesarean Section (CS) is one of the most common obstetric operative procedures. The procedure of cesarean section is still challenging in hospitals, from rural areas of low-income countries like Nepal, where health resources remain scarce and limited. The aim of this study is to understand the prevalence of cesarean section, clinical indications that prompts CS and maternal complications following CS. Methods: In this descriptive cross-sectional study, all cases of delivery at Ilam District Hospital from Jul 16, 2017 to Jul 15, 2018 were included. Ethical approval was obtained from the institution. Patients attending the hospital were from hilly and remote areas of Ilam, Pachthar and Taplejung districts. The prevalence, clinical indications and outcomes of CS were recorded. Data analysis were conducted using Microsoft Excel. Results: The prevalence of cesarean section was 162(14.70%). The mean maternal age was 24.59 (range 17-39) years. Fetal distress was the leading indication and accounted for 57(35.18%) cases for CS, followed by non-progress of labour 40(24.69%), failed induction 23(14.19%), Cephalopelvic disproportion 17(10.49%) and Breech or malpresentation 11(6.79%). Most of the patients were primigravida 115(70.98%) and mean gestational weeks was 40.21(range 36-44). No major maternal complications were noted. Neonatal mean weight was 3.52(2-5.5) kg and APGAR score of more than 6 at 5th minute were recorded in 158 (97.53%) of newborns. Conclusion: The CS prevalence in our study was within the WHO recommendations of 10-15%. The leading indications for CS were fetal distress and no major complications were seen in mothers or newborns following CS.