BACKGROUND: Cesarean section (CS) is an essential, life-saving procedure when clinically justified. However, exceeding the World Health Organization's recommended prevalence (10-15%) may lead to adverse outcomes. This study aimed to determine the prevalence of CS at Rwamagana Hospital and to assess the associated factors. METHODS: This cross-sectional study was conducted among 426 postpartum women at Rwamagana Hospital. Data were analysed using the Statistical Package for the Social Sciences (SPSS). Descriptive statistics and multivariable logistic regression were employed. Statistical significance was set at a 5% level. RESULTS: The results showed a 38% prevalence of CS. Women younger than 25 years were 9.51 times more likely to undergo CS compared to those aged 36-45 years (AO:9.51, 95% CI: 3.37-26.83, p < 0.001), Fetal malposition (AOR:106.8, 95% CI: 29.89-382.25, p < 0.001), experiencing no labour (AOR: 4.64, 95%CI: 1.71 - 12.63, p = 0.003), and first-time mothers (Parity=1) (AOR: 19.65, 95%CI: 8.91-43.33, p<0.001) were positively associated with CS. However, Previous vaginal birth reduced the odds of CS by 89% (AOR:0.11, 95% CI: 0.06-0.21, p < 0.001). CONCLUSION: The prevalence of CS at Rwamagana Hospital exceeds the WHO recommendation. There is a need for enhanced community education to support safe vaginal deliveries.