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Extracorporeal membrane oxygenation (ECMO) is being used with increasing frequency to support patients suffering from severe cardiac or respiratory failure. In pregnancy, ECMO has resulted in favor-able maternal and fetal outcomes. However, there is a paucity of information regarding ECMO man-agement in the peripartum period, including the ideal method of delivery. A case series of four pa-tients describes 100 per cent survival of the mother and fetus where delivery was performed when the patients were on ECMO. In all of these cases, de-livery was performed via cesarean section. Further investigation has revealed that all current informa-tion available in regard to this topic describe delivery via cesarean section only. Here, we describe a case in which a vaginal delivery was successfully performed when on ECMO, without significant blood loss or circuit complication. We describe our management strategies regarding maternal anticoagulation pre- and postvaginal delivery.