To inform obstetricians of a serious complication of forceps rotations of 90 degrees or more--high cervical spinal cord injury in neonates. We reviewed the obstetric aspects of 15 cases of high cervical spinal cord birth injury diagnosed during 1982-1994 at two tertiary-care children's hospitals in Canada. The common feature in all cases was a forceps cephalic delivery, almost always a rotation of 90 degrees or more from the occipitoposterior or occipitotransverse position. High cervical spinal cord injury in neonates is a rare but specific complication of forceps rotation.