Recent investments have shown that Caesarean Section (CS) has been on a steady increase for the past 25 years globally and risk factors associated with CS have been documented yet there is little knowledge on the indications of CS in Siaya County Referral Hospital, rural western Kenya. Hence, the objectives of this study were to determine the prevalence of CS in Siaya County Teaching and Referral Hospital, compare the CS rates among the adolescent-young women pregnancies, and adult pregnancies, investigate whether there is an increase in CS rates in Siaya County Teaching and Referral Hospital. Lastly, to investigate on previous CS, parity, hospitalization, HIV/AIDS and antenatal care patterns as the leading risk factors associated with CS delivery among pregnant women in Siaya County Referral Hospital. The study defined cases as caesarean deliveries while virginal births were controls. The research applied unmatched case-control study design (1 caesarean birth vs 2 virginal births) where 417 records of pregnant women were extracted from the Influenza in Pregnancy Cohort Study database stored in encrypted KEMRI-CDC computers. Total population sampling was used to extract all caesarean sections that occurred between 2017 to January 2020. Controls were extracted by convenience sampling. Descriptive analyses of the continuous and categorical variables were done by calculating the means and proportions. For the bivariate analysis, chi-square test was used to compare differences in various exposures of interest. Odds ratios (OR) was calculated to test various exposures for associations with the outcome variable. Exposures with p-Value <0.15 were then included into the multiple logistic regression model using either backward or forward selection process for the calculation of adjusted odds ratios (OR) in which, all exposures with p-value <0.05 were independently associated with the caesarean delivery. This study detected an increase in the trend by proportion of CS from 2017 to January 2020. The results from multivariate analysis indicated that history of hospitalization (ₐOR=2.92; 95% CI 1.14, 6.05, p<0.001), previous caesarean section (ₐOR=2.92; 95% CI 1.14, 6.05; p<0.001) and antenatal care (ₐOR=15.94; 95% CI 1.77, 142.29; p<0.001) increased the risk of caesarean delivery. In conclusion, previous caesarean, history of hospitalization and antennal care patterns were the main reasons leading to caesarean section. Hence, understanding the predictors of caesarean delivery will help the public health experts to adopt interventions that would reduce incidence of CS and the postpartum infectious morbidity caused by caesarean section among pregnant women during CS delivery.