Precipitous or emergency department (ED) delivery is an infrequent but stressful event that requires preparation to comfortably approach and safely manage. This can include the development of ED delivery checklists and kits as well as appropriate expedited consultant notification (i.e., paging lists). Complications are rare but include shoulder dystocia, prolapsed umbilical cord, and breech presentation. If a shoulder dystocia is encountered, a series of effective maneuvers can be employed and should start with the McRoberts maneuver with concurrent application of suprapubic pressure and proceed to include rotational or internal maneuvers. Management of a prolapsed umbilical cord should start with elevation of the presenting fetal part to alleviate pressure off the umbilical cord and expedited obstetric assistance for emergent cesarean section. Breech delivery is best managed by allowing the mother to deliver the fetus with no assistance in delivery until the umbilicus is visualized.