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Objectives: The objective of the study was to assess how the current COVID-19 pandemic has affected cesarean section (C-section) rates, indications, and peripartum outcomes. Methods: This was a retrospective cross-sectional study that compared a 3-month rates of and indications for C-sections at three tertiary health care institutions in Nigeria before (October 2019–December 2019) and during the first wave of COVID-19 pandemic (March 2020–May 2020). Primary outcomes were C-section rate and indications between the two periods. Data were analyzed using SPSS 26.0 IBM Corporation. Rates and odds ratios with 95% confidence intervals were used to quantify indications and peripartum outcomes and statistical significance was accepted when p value was Results: The baseline characteristics of the two groups were similar. The C-section rate during the COVID-19 period was significantly less than the period prior to the pandemic (237/580, 40.0% vs 390/833, 46.8%; p = 0.027). The rates of postdatism (odds ratio = 1.47, 95% confidence interval = 1.05–2.05, p = 0.022), fetal distress (odds ratio = 3.06, 95% confidence interval = 1.55–6.06, p = 0.017), emergency C-section (odds ratio = 1.43, 95% confidence interval = 1.01–2.05, p = 0.042), and anemia (odds ratio = 1.84, 95% confidence interval = 1.12–3.03, p = 0.016) were significantly higher during the pandemic than prepandemic. Conclusion: The overall C-section rate during the first wave of COVID-19 was significantly lower than the prepandemic period. There were higher rates of postdatism, fetal distress, emergency C-section, and postpartum anemia. Further studies on this changing C-section trend during the pandemic are needed.