The relationship between fetal head compression and the occurrence of intraventricular hemorrhage was examined in 101 very-low-birth-weight (500 to 1500 g) vertex neonates. Peripartum events related to head compression, including parity, rupture of membranes, labor, episiotomy, use of forceps, and cesarean birth were not significantly related to intraventricular hemorrhage. A birth weight of less than 1250 g, neonatal depression (one minute Apgar score less than 7), respiratory distress syndrome, and neonatal mortality were significantly associated with intraventricular hemorrhage (P < .05). These findings suggest that head compression in the vertex very-low-birth-weight fetus, as encountered in current obstetric practice, is not a major determinant of intraventricular hemorrhage. When premature delivery is inevitable, focusing on efforts to avoid a depressed one-minute Apgar score appears to be a more promising approach for the prevention of intraventricular hemorrhage than routinely using cesarean birth.