BACKGROUND Incidence of elective caesareans at term is increasing these last decades with an associated increase of neonatal respiratory morbidity. OBJECTIVE To analyse the influence of elective Caesarean delivery at term on the incidence of neonatal respiratory distress in order to propose an effective strategy of prevention. METHODS It is an analytical study compiling all births resulting from elective Caesarean at term (gestational age ranging between 37 and 41+6 GA), reported over two years period at the Charles Nicolle hospital (Tunis-Tunisia). We compared 250 live births, without maternal risk factors, delivered by elective Caesarean to 250 births delivered by vaginal way. RESULTS Frequency of the elective Caesarean at term was of 3.6% live births; it was mainly indicated in the presence of a cicatricial uterus. The incidence of respiratory morbidity was 6% (15/250) in the group exposed to the elective caesarean versus 1.6% (4/250 cas) in the reference group, OR=3.9; 95%CI: [1, 28-11, 99] p<0.01. Before the term of 39 GA, OR=5.22; 95%CI: [1.14-23.87] p=0.01. After 39 GA, the risk of respiratory distress decreased: OR=1.86 95%CI: [0.30, 11.35] NS. The principal etiology of respiratory distress in the exposed group was the transitory tachypnea of the newborn. CONCLUSIONS Incidence of respiratory distress was higher at newborn babies born from elective Caesarean with a significant reduction in this incidence after the term of 39 GA.