Objective: To determine the contribution that pre-labor cesarean (cesarean performed without attempting vaginal birth) makes to all cesarean births, and to cesarean births within subgroups of the pregnant population. Design: Retrospective cohort study. Setting: 15 hospitals in the Pacific Northwest of the United States. Population: Births at 23+0-42+6 weeks’ gestation between January 1, 2017 and March 31, 2018. Methods: Review of clinical data abstracted from medical records. Main Outcome Measures: The contribution of pre-labor cesarean to all cesareans and to primary cesareans. The indications for pre-labor primary cesarean in singleton term cephalic pregnancies. Results: Of 32756 births in the study population, 10290 (31.4%) were cesarean births. Pre-labor cesareans represented: 63.7% of all cesareans; 32.4% of cesareans in nulliparas; 58.7% of cesareans in multiparas with no history of cesarean; and 20.0% of all births. Pre-labor cesareans constituted 68.3% (2418/3542) of cesareans in singleton term cephalic multiparas with one previous cesarean, 89.4% (356/398) of cesareans in multiple pregnancies, and 53.2% (216/406) of cesareans in twin pregnancies where Baby A was cephalic. In singleton term cephalic pregnancies with no previous cesarean 18.3% (674/3682) of cesareans were pre-labor and suspected macrosomia (28.9%) and maternal request (18.1%), jointly accounted for 47.0% of indications for these surgeries. Conclusions: Cesarean without attempting vaginal birth is a major contributor to both primary and repeat cesarean birth rates. Greater tracking of the rate and indications for these cesarean births may be important in the effort to understand and potentially reduce the primary cesarean birth rate.