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Background. Some special problems of neonates are related to the adverse effects of delivery such as birth trauma with high mortality and morbidity. The aim of this study was to determine the incidence of birth trauma and related risk factors in a referral hospital in Rafsanjan, a city in the south of Iran. Materials and methods. In this cross-sectional study, we reviewed medical records of all 3340 live neonates that were born between March 2004 and March 2005 at Nicknafs maternity center. Special questionnaires of study were completed and data was analyzed. Results. Among all neonates, 0.8% of them had birth trauma. The most common types of trauma were cephalohematoma 37.03%, massive hematoma 37.03%, and clavicular fracture 11.2%. The incidence of brachial plexus injury and clavicular fracture was higher in macrosomic neonates, whereas cephalhematoma, skin injury and massive hematoma were more prevalent in microsomic neonates. Neonatal birth trauma was more frequent in vaginal delivery than cesarean section (1.3% vs 0.1%, p = 0.0001). However, the incidence of birh trauma in instrumental delivery and normal vaginal delivery were similar (2.8% vs 1.3%, p = 0.303). Conclusion. The incidence of birth trauma in this region is 0.8% and birthweight and normal vaginal delivery are strong predictors for birth injuries. [ABSTRACT FROM AUTHOR]