Pregnancy-related complications can lead to respiratory failure, which includes failure to oxygenate and/or ventilate. While there are normal physiologic changes in respiratory status in pregnant women, respiratory depression and hypoxia can still place the mother and fetus in jeopardy. In this paper, we propose an approach to managing and treating pregnant women with respiratory failure. First, we address the physiologic changes and respiratory pathology in pregnancy. Next, we examine a stepwise approach to oxygenation from noninvasive oxygenation to a mechanical ventilation strategy in pregnant patients. We then address specific respiratory pathologies common in pregnant patients and how to manage them. Finally, we discuss an approach to advanced cardiac life support in this patient population.