INTRODUCTION: The primary objective was to determine if immediate postpartum placement of intrauterine devices at time of cesarean delivery was associated with increased rates of malpositioned devices compared with placement after vaginal delivery. METHODS: This was a retrospective cohort of 126 women who received immediate postpartum intrauterine device placement (either a postplacental levonorgestrel or copper) following vaginal or cesarean delivery over a two year period between May 2015 to May 2017 at a tertiary care center. Women were followed for 12 weeks postpartum. RESULTS: A total of 126 women were analyzed in this study (N=63 for vaginal deliveries and N=63 for cesarean delivery). Baseline demographic characteristics between the vaginal delivery and cesarean delivery groups were similar. The total discontinuation of IUD secondary to malposition or expulsion was 33% (N=42; 25% at time of cesarean delivery versus 41% at time of vaginal delivery) at 12 weeks post-partum. Expulsion of the IUD was significantly more common in the vaginal delivery group (31.7% versus 12.7%, p=0.017). There was no difference in malposition between the two groups (9.5% in vaginal delivery group, 14.2% in cesarean delivery group, p=0.58). There was a significant increase in use of ultrasound to determine IUD position amongst the cesarean delivery group (46.0% vs. 12.7%, p=0.00003). CONCLUSION: Immediate post-placental IUD placement after vaginal delivery resulted in a higher occurrence of expulsion than following cesarean delivery. We did not observe a significant difference in malposition of intrauterine devices following placement after vaginal delivery compared with cesarean section.