Background: Rates of cesarean delivery continue to increase among Hispanics, the largest minority group in the United States. Prior studies of the relationship between physical activity and cesarean delivery have been conflicting, limited by questionnaires not validated for pregnancy, and conducted primarily among non-Hispanic whites. Methods: We evaluated this association among participants (n = 1313) in Proyecto Buena Salud, a prospective cohort of Hispanic women conducted from 2006 to 2011. Physical activity was measured via the Pregnancy Physical Activity Questionnaire. Results: In total, 320 (24.4%) participants delivered via cesarean. In multivariable analyses, increasing levels of sedentary activity in mid/late pregnancy were associated with higher odds of cesarean delivery (odds ratio = 1.54; 95% confidence interval, 1.02–3.33; P trend = .05); however, there were no clear patterns between physical activity and cesarean delivery. When we repeated the analysis excluding planned cesarean deliveries (n = 126), high levels of prepregnancy moderate-intensity physical activity (odds ratio = 0.61; 95% confidence interval, 0.38–0.99) and increasing moderate-intensity physical activity in mid/late pregnancy (P trend = .03) were associated with reduction in odds. Increasing levels of household/caregiving physical activity in pre and mid/late pregnancy were associated with a 50% reduction in odds (P trend < .05). Conclusions: In this prospective cohort of Hispanics, sedentary activity increased odds of cesarean delivery, and moderate-intensity and household/caregiving physical activity reduced odds of unplanned cesarean deliveries.