Caesarean section is a major surgical intervention that involves high costs and adverse outcomes, such as surgical complications, compared to vaginal delivery (1—3). The C-section rate in Puerto Rico increased from just over 30% in the early and mid-1990s to more than 40% in the early 2000s (4.5). During this period, C-section rates in Puerto Rico were between 40% and 70% higher than those in the continental United States and up to 78% higher than those reported in Hispanic women from the same territory (4.5). This report describes trends in the C-section rate in Puerto Rico from 2010 to 2022 and analyzes changes by maternal age, gestational age and municipality between 2018 and 2022.