Fetal surgery is the antenatal treatment of fetal malformations that can not be adequately treated after birth. Anesthesia for fetal surgery involves two patients, and issues of maternal safety, avoidance of fetal asphyxia, adequate fetal anesthesia and monitoring, and uterine relaxation are important. Communication with the surgeon to determine the surgical approach and for uterine relaxation allows the anesthesiologist the ability to vary the anesthetic technique. Lessons learned from fetal surgery may help other neonates with life-threatening anomalies and may help understand the correct issue related to preterm labor.