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Objective: The objective of the study was to determine the decision to delivery interval and the associated maternal and neonatal outcomes at Thika level five hospital. Design: Ambidirectional study Setting: Secondary Level Hospital in Kenya Subjects: Four hundred and nineteen mothers who underwent emergency caesarean section and their newborns Main outcome measure: Decision to delivery interval, maternal and neonatal outcomes. Results: The median decision to delivery interval was 248 minutes. Only 1% attained the recommended decision to delivery interval of≤ 30 minutes. Majority of the participants (40.1%) had a decision to delivery interval above 300 minutes. Six percent of the mothers developed complications among which postpartum haemorrhage accounted for 1.9%(n= 8), wound sepsis 0.7%(n= 3), ruptured uterus 0.5%(n= 2) and maternal deaths recorded were 0.5%(n= 2). There was no …