Complications arising during out-of-hospital childbirths, whether planned home births or unplanned, present a rare and difficult challenge for EMS physicians and clinicians as many of the factors that increase the likelihood of out-of-hospital birth also contribute to the development of childbirth emergencies. Abnormal presentations (e.g., breech), umbilical cord prolapse, and shoulder dystocia represent potentially disastrous situations for the fetus and must be managed by EMS clinicians until arrival at definitive care. Initial management techniques and maneuvers for relieving these situations are described along with more complex medical oversight–directed options for fetal rescue. The approach to maternal postpartum hemorrhage, focusing on treatment of uterine atony and modern hemorrhage control techniques, is also reviewed.