Aim: To determine the association between the mode of delivery and selected neonatal and maternal morbidities and outcomes in NSW, during 1998-2008. Methods: This study is a retrospective review of NSW Midwives Data Collection (MDC) of 981,178 deliveries during 1998-2008. Maternal condition and neonatal outcomes were compared for different modes of delivery. Results: The annual rate of caesarean section has steadily increased from 19% to 31.1% with a mean of 25.9% during the study period. The risk of neonatal death was higher for forceps-assisted delivery compared to vacuum-assisted delivery (adjusted odds ratio 0.85%, 95% CI 0.52 - 1.37), caesarean section (adjusted odds ratio 1.14%, 95% CI 1.01 - 1.3) and normal vaginal delivery. Operative vaginal delivery and caesarean section had significantly increased risk for maternal mortality compared to normal vaginal delivery. Conclusions: There is an association between maternal and neonatal outcome and mode of delivery. Mothers and babies with normal vaginal delivery achieved better outcomes in this community. Caesarean section and operative vaginal delivery are associated with significant maternal and neonatal risk. Breech vaginal delivery carries a significant neonatal risk. More future prospective analyses, such as multicentre controlled studies, should be designed to determine whether and how much the adverse pregnancy outcomes were caused by unnecessary surgical and operative vaginal delivery.