Background <p>Variations in obstetric care across different shifts may affect the timing of emergency interventions and perinatal outcomes. However, evidence on the combined relationship of shift timing with emergency cesarean delivery rate, decision-to-delivery interval (DDI), and neonatal outcomes remains limited.</p> Objectives <p>To evaluate emergency cesarean delivery rates and neonatal outcomes according to delivery shift, and DDI according to decision shift among emergency cesarean deliveries.</p> Design and setting <p>Single-center retrospective cohort study conducted at a tertiary university hospital.</p> Methods <p>Women with term singleton live births between January 1, 2020, and December 22, 2025, were included. The primary outcome was emergency cesarean delivery rate according to delivery shift. Secondary outcomes included mean DDI, prolonged DDI (&gt; 30&#xa0;min), Apgar scores, neonatal intensive care unit admission, and composite neonatal outcome. Hierarchical multivariable logistic regression was used to identify factors associated with prolonged DDI.</p> Results <p>Among 1000 births, 380 (38.0%) were emergency cesarean deliveries. Emergency cesarean delivery rates were lowest during daytime and higher during evening and night shifts (32.2%, 40.6%, and 43.4%; <i>p</i> = 0.006). Among emergency cesarean deliveries, mean DDI and prolonged DDI increased significantly from daytime to night decision shifts (<i>p</i> &lt; 0.001). Prolonged DDI was not significantly associated with composite neonatal outcome.</p> Conclusions <p><?tk 2?>Delivery shift was associated with emergency cesarean delivery rates, whereas decision shift was independently associated with prolonged DDI. Although prolonged DDI was not associated with adverse neonatal outcomes in this cohort, the findings suggest potential organizational differences in emergency obstetric care across shifts.</p>