The authors present a rare case of a pregnant woman who had an emergency tracheostomy procedure during the third trimester of pregnancy due to respiratory distress, secondary to bilateral vocal cord paralysis. The patient achieved a vaginal delivery by coordinated occlusion of the tracheostomy during the pushing efforts. Data concerning antenatal management and mode of delivery in women with vocal cord paralysis and/or tracheostomy are extremely rare. Main concern in pregnant women with tracheostomy is their ability to perform Valsalva maneuver efficiently during the second stage of labor. However, when the women desires a vaginal delivery, provided that there is a good support to the laboring woman and a team of experts available, vaginal delivery should be attempted.