The increasing rates of overweight and obesity in women of childbearing age, combined with the risks of poor outcomes for the mother-child dyad, make it imperative for midwives to be aware of the evidence. This chapter describes the evidence-based best practices for the preconception, antepartum, intrapartum, and postpartum care of the obese woman. In addition, in providing care to the normal-weight pregnant woman with a history of gastric surgery for weight loss, the midwife needs to be cognizant of unique clinical considerations that deviate from routine care. During preconception/well-woman visits, the midwife needs to obtain accurate height and weight measurements, determine body mass index (BMI), and tactfully discuss BMI outside the defined limits as a risk in pregnancy. Obese women are at greater risk of giving birth to an infant with congenital anomaly. The midwife needs to counsel the obese pregnant woman about options available for screening for congenital anomalies.