Difficult calving may adversely affect dairy cow health and performance. Maternal:fetal disproportion is a major cause of dystocia. Therefore, the main objective of this study was to assess the effects of dam:calf body weight ratio (D:C) on calving difficulty, rumination time, lying time, and inflammatory profile in 25 Holstein dairy cows. Using automatic monitoring systems, we monitored behavior and production in 9 primiparous and 16 pluriparous cows between dry-off and 30 d in milk. During the same period, we collected blood samples to monitor metabolism and inflammatory profile of these cows. Calvings were video recorded to assess calving difficulty and observe the duration of the expulsive stage. After parturition, the cows were separated into 3 classes according to their D:C: easy (E; D:C >17), medium (M; 14 < D:C <17), and difficult (D; D:C <14). The cows in class D showed relatively longer labor durations (108 min vs. 54 and 51 min for classes D, M, and E, respectively) and higher calving assistance rates (50% vs. 0 and 11% of calvings for classes D, M, and E, respectively) than those in the other 2 classes. Compared with the cows in classes M and E, those in class D exhibited shorter rumination times on the day of calving (176 min/d vs. 288 and 354 min/d for classes D, M, and E, respectively) and during the first week of lactation (312 min/d vs. 339 and 434 min/d for classes D, M, and E, respectively) and maintained lower rumination values until 30 DIM (399 min/d vs. 451 and 499 min/d for classes D, M, and E, respectively). Primiparous class D cows had shorter resting times during the first week after calving compared with those in class M (8 vs. 11 h/d for classes D and M, respectively). Interclass differences were found in terms of the levels of inflammation markers such as acute-phase proteins (ceruloplasmin, albumin, retinol, and paraoxonase). Moreover, cows in class D had lower plasma levels of fructosamine and creatinine after calving. Low D:C reduced postcalving rumination time and increased inflammation grade, suggesting a lower welfare of these animals at the onset of lactation. The D:C might serve as a useful index for the identification of cows at relatively higher risk of metabolic and inflammatory disease, thus helping farmers and veterinarians improve the welfare and health of these cows.