The overall incidence of maternal birth injury was 5.75% (23 cases) including; vaginal tear (26%), third degree perineal tear (21.7%), cervical tear (17.3%), postpartum hemorrhage (8.7%), fourth degree perineal tear (13%) and multiple maternal injury (13%) In this study all cases with maternal height less than 150 cm were delivered by CS. Also In this study all cases with actual birth weight ≥5000 g were delivered by CS and 75% (6 /8) of cases with birth weight ≥ 4500 g were delivered by CS and heavier birth weight was associated with higher rate of CS P<0.001. In this study the rate of macrosomia (≥4000g) was 14.5% and it was associated with higher rate of birth injury specially shoulder dystocia and postnatal asphyxia and vaginal tears.The rate of emergency caesarean section was 10.25% and the main indications were; failure to progress in the first stage of labor (in 43.9% of cases), failure to progress in the second stage of labor (in 34.1% of cases) and fetal distress (in 21.9% of cases).