Objective: We compared birth injuries for vaginal (VD) and caesarean section (CS) deliveries in preterm and term pregnancies. Study design: 10-year retrospective study of singleton pregnancies delivered after 24 0/7 weeks, in a single tertiary center, between January 1st, 2007, and December 31st, 2017. Multivariable analyses compared trauma at birth, birth hypoxia and birth asphyxia in term and preterm deliveries, stratified by mode of birth, VD versus CS. Results: The incidence of preterm deliveries was 10.9 %. Delivery of preterm babies by CS increased from 37.0% in 2007 to 60.0% in 2017. The overall incidence of all birth trauma was 16.2 %. When stratified by mode of delivery, birth trauma was recorded in 23.4 % in vaginal deliveries and 7.5 % in CS deliveries (aOR 3.3, 95 %CI 3.1-3.5). Incidence of trauma at birth was higher after 28 weeks gestation in VD compared to CS (28-31 weeks, aOR 1.7, 95 % CI 1.3-2.3; 32-36 weeks, aOR 4.2, 95 % CI 3.6-4.9; >37 weeks, aOR 3.3, 95% CI 3.1-3.5). There was no difference in birth trauma before 28 weeks gestation between VD and CS (aOR 0.8, 95% CI 0.5-1.2). Conclusion: CS is not protective of injury at birth. When all types of birth trauma are considered, these are more common in VD, thus favoring CS as preferred method of delivery to avoid trauma at birth. However, when stratified by severity of birth trauma, preterm babies delivered vaginally are not at higher risk of major birth trauma than those delivered by CS.