To describe appropriate maternal and obstetrical indications for primary cesarean delivery. The list of potential indications is long. Among all maternal and obstetrical indications, labor dystocia is the most common; multifetal pregnancy and malpresentation are not infrequent. Maternal indications, including human immunodeficiency virus (with high viral load) and herpes simplex virus (with active lesions), are rare. Preeclampsia alone typically is not an appropriate indication for cesarean delivery. Although the need for a cesarean is absolute for some conditions, such as complete placenta previa or placenta accreta, minimum criteria for a cesarean are variable and subjective for many indications, including dystocia. The subjective diagnosis of labor dystocia provides the best opportunity to prevent the first cesarean. © 2012 Elsevier Inc.