The management of a pregnant patient in cardiac arrest encountered in the out‐of‐hospital setting is a challenging event, with two patients to consider: the mother and fetus. Perimortem cesarean section (PMCS) is a recommended component of maternal resuscitation for pregnant patients after 20‐24 weeks gestation as a means of facilitating survival of both the baby and mother. This chapter discusses the potential benefits and indications for PMCS. Prior case reports and case series in the medical literature are reviewed, and challenges of performing PMCS in the field are discussed. A description of the procedure provides detailed instruction, including the equipment necessary to perform this procedure in the out‐of‐hospital setting. Ethical and legal considerations are also discussed. Through a review of the perimortem cesarean section and its performance in the field, EMS physicians will be better able to manage the out‐of‐hospital resuscitation of a pregnant patient in cardiac arrest.