Labor and delivery carry significant risks in this patient group, for several reasons. The increased work and oxygen consumption may not be tolerated by these patients. Furthermore, patients with kyphoscoliosis may have associated pelvic abnormalities, impeding normal delivery,4 and their spinal deformity may significantly affect the ability to provide epidural or spinal anesthesia for delivery.12 In the cases we describe, the management approach for each patient was discussed in a multidisciplinary meeting, which included representatives from obstetrics, maternal-fetal medicine, obstetric anesthesia, critical care and respirology, and nursing, and other disciplines as necessary. The route of delivery was based on obstetric criteria, and the decision to use neuraxial anesthesia was based on clinical findings and imaging (prepregnancy spinal radiographs or MRI). The final mode of delivery and anesthesia appear to differ depending on the underlying disease (Table 1). The women with parenchymal lung disease underwent vaginal delivery with epidural anesthesia, with the exception of one patient who required cesarean section for preeclampsia. Among the 10 pregnancies in women with chest wall or neuromuscular disease, all except one were delivered by cesarean section. In one-half of these deliveries, neuraxial anesthesia was not considered possible or failed, and these patients required a general anesthetic for their operative delivery.