This case report of a woman with severe (Grade IV) kyphoscoliosis describes the complexities of providing care to women with this debilitating maternal condition. The literature was reviewed for the related obstetrical management issues associated with kyphoscoliosis and pregnancy. Incidence and causes of kyphoscoliosis are described, as well as recognized methods of determining the severity of spinal curvature. The three health considerations for pregnant women with kyphoscoliosis are reviewed. Cardiopulmonary complications may arise in women with primary curvature in the thoracic spine. Conversely, women with the primary curvature in the lumbar spine have a higher risk of such obstetrical complications as cephalopelvic disproportion. Finally, a concern in women with kyphoscoliosis is whether pregnancy will worsen spinal curvature. This article emphasizes the importance of a multidisciplinary approach in caring for obstetrical patients with kyphoscoliosis.