Obese women should be strongly encouraged to lose weight before conceiving to decrease obstetric and perinatal morbidity and mortality. Careful systemic evaluation should be performed at the first opportunity during pregnancy in morbidly obese women to determine the systemic pathophysiologic alterations of obesity. It is strongly recommended that the pregnant woman should be seen by an anesthesiologist at around 28 weeks gestation to determine the effect of pregnancy on various systems. A multidisciplinary approach should be instituted depending on the systemic findings. Careful evaluation of the airway should be performed, and an anesthetic plan formulated and communicated to the patient as well as the obstetrician. Regional anesthesia is most appropriate for labor and delivery. An early administration of epidural anesthesia is recommended, which will provide ample time to negate difficulties encountered during epidural placements. Continuous spinal anesthesia is a reasonable alternative. If general anesthesia is contemplated, a second pair of hands is a boon, and necessary airway backup equipment should be at hand. A multidisciplinary approach is the key to a successful outcome of pregnancy in morbidly obese women.