Little is known about the use of monoamine oxidase inhibitors (MAOIs) during pregnancy and the postpartum period. We present a literature review with what we believe is the second case report of phenelzine exposure throughout pregnancy and the postpartum period. Potential indications for use and principles of the clinical management of the pregnant patient treated with an MAOI are also discussed and include: documenting informed consent, MAOI dose adjusting during pregnancy, monitoring of maternal and fetal outcome, and appropriate analgesia and anesthesia during labor and delivery. Our patient tolerated phenelzine well throughout her pregnancy but experienced recurring depressive symptoms during periods of significant weight gain requiring dose adjustment. Labor, delivery, and the perinatal period progressed without complication for our patient and her infant, in whom no congenital malformation was detected. Additional case reports and animal studies of MAOI use during gestation may help determine safety and refine clinical management guidelines.