To assess the influence of labor and delivery events on the risk of germinal matrix hemorrhage in preterm newborns, we conducted a review of data collected on 449 babies who weighed 1.5 kg or less. Babies delivered vaginally were more likely to have germinal matrix hemorrhage than were babies delivered abdominally (odds ratio, 2.5; 95% confidence interval, 1.4,3.3). Among babies delivered vaginally, the risk of germinal matrix hemorrhage was increased by 39% if labor lasted more than 12 hours. Among babies delivered abdominally, the occurrence of any labor was accompanied by a 150% increased risk of germinal matrix hemorrhage. The only indication for abdominal delivery associated with an increased risk of germinal matrix hemorrhage was impending amnionitis (odds ratio, 2.6; 95% confidence interval, 1.2,5.7), whereas the only indication associated with a decreased risk was preeclampsia (odds ratio, 0.2; 95% confidence interval, 0.6). Epidural and local anesthesia were associated with a reduced risk of germinal matrix hemorrhage among babies delivered abdominally. We conclude that delivery practices, or their indications, appear to influence the risk of germinal matrix hemorrhage in low birth weight babies.