INTRODUCTION: Shoulder dystocia remains an unpredictable obstetrical emergency with potential for significant neonatal morbidity. Expert opinion recommends consideration of cesarean delivery for suspected fetal macrosomia of greater than 5000 g or 4500 g in diabetic patients, irrespective of other patient characteristics. The objective of this study was to identify risk factors for shoulder dystocia in our patient population. METHODS: This retrospective cohort study looked at singleton, term, vaginal deliveries from September 1, 2008 to December 31, 2014 at a single community hospital. Labor and delivery characteristics as well as maternal and fetal outcomes were compared between those with and without a shoulder dystocia. Risk factors were assessed using univariate and multivariate logistic regression models. A classification tree was utilized to identify independent risk factors associated with the highest incidence of shoulder dystocia. RESULTS: Our final sample included 8,930 deliveries with 299 (3.3%) shoulder dystocias. Independent risk factors included maternal Asian, African American, or Hispanic descent, diabetes, oxytocin augmentation, operative delivery, and increased fetal birth weight. Furthermore, the combinations associated with the highest incidence of shoulder dystocia were 1) nulliparous, birth weight 4000-5000 g [40.9%], 2) multiparous, diabetes, birth weight 4000-5000 g [30.8%], 3) nulliparous, birth weight 3500-4000 g [15.4%], 4) multiparous, birth weight 4000-5000 g [14.6%]. CONCLUSION: Here, we identified risk factor combinations with higher incidence for shoulder dystocia than the American College of Obstetricians and Gynecologists' threshold for recommending a cesarean section based on fetal macrosomia alone. Individualized risk assessment should be performed with emphasis on counseling and delivery options particularly in these high risk patients.