BACKGROUND: Decision to delivery interval (DDI) is the time line between a decision to conduct an emergency caesarean section and actual delivery of the baby. Prolong DDI constitute a third phase delay in provision of emergency obstetric care. Intervention designed to minimize DDI are vital, in attempt to prevent maternal morbidity and neonatal morbidity and mortality. The feasibility and practicability of the recommended DDI in recent studies have been questioned especially in limited resource setting and therefore the objective of this study was to determine the DDI and its associated factors. OBJECTIVE: To asses Decision to Delivery Interval and its associated Factors among Emergency Caesarean Section Deliveries at Tibebe Ghion Specialized Hospital Northwest Ethiopia. METHODS: cross-sectional study was conducted at Tibebe Ghion Specialized Hospital Bahir Dar city, Ethiopia, from February 1/2023- to –JUNE30, 2023 GC. A total of 244 mothers who had emergency cesarean section were included in the study. Systematic sampling was used. The collected data was cleaned, coded and entered into coded and entered into SPSS version 25 for analysis and bivariate analysis was computed. Binary logistic regression using bi-variate and multi-variable regression analysis was done. Statistical significance was considered at P value of less than 0.05 and the strength of association was assessed by odds ratio (OR) and respective confidence intervals (CIs). Result: only 24.3% of participants had a decision to delivery interval of ≤30minutes. The overall mean of DDI was 46 ± 16 minutes. The mean duration for anesthesia time was 13.4±7 minutes. Anesthesia time [AOR = 5.8, 95%CI = 2.6–12.9] and anesthesia type [AOR=12.8, 95%CI=2.4-6.9] were the predictors of prolonged decision to delivery interval. Conclusion: in most cases decision to delivery interval was achieved within the recommended time interval. In this study anesthesia time and anesthesia type has statistically significant association with prolonged DDI. Keywords: emergency cesarean section, decision to delivery interval