Recurrent respiratory papillomatosis is a benign neoplastic process involving squamous epithelium of the respiratory tract, typically the vocal folds. In cases of aggressive growth, or uncontrolled disease, airway compromise and respiratory distress can occur. Human papillomavirus (HPV) is known to be the etiologic agent in this disease process, as well as in condyloma acuminata, or genital warts. Studies have shown that HPV-induced condyloma acuminata can worsen during pregnancy. We present a case of airway obstruction requiring emergent tracheostomy in a pregnant patient with known laryngeal recurrent respiratory papillomatosis. The management of this condition and some theories regarding its response to certain hormonal states are discussed.