The Agency for Healthcare Research and Quality Quality Indicator tools were used to identify risk factors for maternal birth-related trauma rates in the 2003 Nationwide Inpatient Sample and the 2002-2004 Iowa State Inpatient Database. Risk-adjusted analyses of these datasets isolated salient risk factors for maternal trauma. The rates of Iowa's risk factors for the most serious types of trauma--third/fourth-degree lacerations--were compared with national rates. The comparisons suggest that episiotomy, artificial rupture of membranes, obstructed labor, and late pregnancies are the most salient risk factors for third/fourth-degree lacerations within Iowa. Thus, this research suggested that a combination of maternal, baby, and episiotomy factors contributed to the high prevalence of third/fourth-degree lacerations in vaginal deliveries in Iowa. Finally, our risk-adjustment methodology could be used in a similar manner to analyze other discharge datasets for opportunities to improve maternal outcomes.