Background <p>Caesarean section (CS) rates are increasing globally. Though CSs are known to contribute to improving maternal and neonatal outcomes, they can result in short and long term complications. We sought to find out the maternal complications associated with primary CSs within six weeks post-delivery in a unique cohort.</p> Methods <p>This was a prospective cohort study conducted at the Korle Bu Teaching hospital, Accra, Ghana. A total of 1013 women who had their primary CS procedure carefully documented between 1st January, 2018 to 14th January, 2020 were followed up to six weeks post -delivery and CS complications observed and documented. Adjusted Poisson Model with Robust Standard Error was used to determine incidence risk ratios for CS complications.</p> Results <p>The primary CS maternal complication rate was 12.3% (CI-10.3-14.4). Surgical site infection (SSI) rate was 32/989(3.2%) and constituted 32/65(49.2%) of all the post-operative complications. Positive cultures for bacteria were obtained in 4/32(12.5%) of the women who had SSI. Factors associated with CS complications include: age 30–34 years compared to teenagers IRR 0.24 [CI: 0.08–0.73], being widowed IRR 7.09 [CI: 1.22–41.38], abnormal vaginal discharge during pregnancy IRR 2.13 [CI: 1.094.17] and electrocoagulation for dissection of subcutaneous tissue IRR 0.44 [CI: 0.21–0.91].</p> Conclusion <p>Primary CS complication rate within the first 6 weeks post- partum is relatively low with the majority being surgical site infections. The risk factors associated with CS complications are; being a teenager, women who are widowed and recurrent abnormal vaginal discharge during pregnancy. The use of diathermy for CS is associated with less risk of CS complications. Identification of these factors and provision of appropriate support and treatment will help to reduce the complications associated with CSs at Ghana’s largest referral teaching hospital and enable women have a more positive pregnancy experience.</p>