This chapter provides an overview of the normal changes in coagulation associated with pregnancy. It discusses the most common challenges experienced by anesthesiologists in the coagulopathic pregnant woman. The result is a hypercoagulable state that maintains placental function during pregnancy and protects the parturient from hemorrhagic complications during delivery but increases the risk of thromboembolism. The risks of neuraxial anesthesia in the coagulopathic parturient must be weighed against the risks of the alternatives and the gravity of the situation. Normal pregnancy imparts an increased tendency toward thrombus formation, extension, and stability. Epidural or spinal hematoma are rare and devastating complications of neuraxial anesthesia in parturients. Their occurrence is almost invariably associated with clinical coagulopathy or the use of anticoagulants. Decisions regarding the most appropriate anesthetic management for obstetric patients can be difficult and fraught with pitfalls.