To prevent maternal hypotension, decreased uteroplacental perfusion, and adverse maternal and neonatal outcomes, ketamine is used as an adjunct to induction of general anesthesia for Cesarean delivery. Subanesthetic dose ketamine is also administered to prevent and treat maternal hypotension during spinal anesthesia. It is used to prevent and reduce maternal stress, pain, and depression before and during delivery with neuraxial analgesia, and during conversion from neuraxial to general anesthesia in emergency situations or when neuraxial blocks are inadequate. Because ketamine crosses the placenta rapidly, concerns about its potential neurotoxicity on the fetal brain remain unresolved. The current evidence on the effects of ketamine on the mother and fetus or newborn during labor and delivery is therefore reviewed. Our analysis indicates that there is no substantial evidence against the use of ketamine, particularly in intrapartum emergencies involving hypoxia. Ketamine may even have neuroprotective effects on both mother and fetus. While subanesthetic dose ketamine may induce transient, mostly mild psychoactive events, its analgesic and other medical benefits typically outweigh the side effects.