Introduction: Due to the increase in the frequency of cesarean section over the past few decades, the Ministry of Health and Medical Education of Iran compiled the guideline to promote natural childbirth within the framework of the health reform plans and communicated it to the country's medical science centers. The present study was conducted with aim to determine the epidemiological characteristics and changes trend of the frequency of cesarean section performed in the three educational hospitals of Mashhad University of Medical Sciences. Methods: In this cross-sectional study, the information of all mothers admitted to the three educational hospitals of Mashhad University of Medical Sciences (Imam Reza, Ghaem and Omol-Banin hospitals) due to pregnancy termination during 12 years period (2007-2018) was extracted from the hospital information system. The analyzed information included age, hospitalization center, type of admission (elective or emergency), number of babies, need to transfer mother to ICU, total hospitalization cost, duration of hospitalization, and mother's insurance coverage status. Data was analyzed by SPSS software (version 26). P