The perinatal nurse is charged with providing safe and effective care in both routine and emergency situations. This duty arises from the states' nurse practice acts and American Nurses Association's Code for Nurses, and it has been affirmed by a growing body of case law. Current changes in health care systems have created new challenges for the perinatal nurse. In some instances, the transformations occurring in health care may actually hinder the nurse's ability to provide care when faced with an obstetric emergency. These changes do not, however, alter the nurse's affirmative duty to take some positive action when complications arise. The article elaborates essential nursing actions required when an obstetric emergency occurs within the context of redesigned maternity settings