Purpose of Review <p>Obstetrical emergencies require rapid and well-coordinated responses to optimize maternal and fetal outcomes. In-situ simulation, which involves simulating emergent scenarios in the clinical environment, is a training method that can enhance team performance. This review examines the role of in-situ simulation in responding to specific emergencies, including emergency cesarean section, umbilical cord prolapse, shoulder dystocia, and post-partum hemorrhage among others. We also discuss challenges with practicing in-situ and strategies to overcome those barriers.</p> Recent Findings <p>In-situ simulation improves communication, adherence to evidence-based management, and decreases response times in cases of obstetrical emergencies. It also helps identify latent safety threats when conducted prior to new facilities opening. However, barriers such as unit acuity, staffing limitations, financial costs, and scheduling disruptions are common and can make implementation challenging. Successful programs have addressed these challenges by engaging leadership support, embedding simulation into routine training, and incentivizing simulation participation for providers.</p> Summary <p>In-situ simulation is a powerful training tool to improve outcomes for obstetrical emergencies. Simulation training enhances preparedness during emergencies, reduces preventable harm, and fosters a culture of safety and communication. With intentional planning and institutional buy-in, simulation training can be implemented while decreasing long term costs and liability and being mutually beneficial to patients, health care providers, and hospital systems.</p>