Primary infection with varicella-zoster virus (VZV) during pregnancy can lead to devastating outcomes for both the mother and fetus. We describe a case of VZV infection in a pregnant woman who presented at 38 weeks’ gestation. We also review the literature regarding management and prevention. Varicella-zoster virus–associated pneumonia in the mother is important to recognize. Outcomes in the newborn largely are dependent on gestational age at the time of infection. Prevention is paramount to management.