Objectives: Characterize the demographics, management, and outcomes of obstetric patients transported by emergency medical services (EMS). Design: Prospective observational study. Setting: Five Indian states utilizing a centralized EMS agency that transported 3.1 million pregnant women in 2014. Participants: This study enrolled a convenience sample of 1684 women in third trimester of pregnancy calling with a “pregnancy-related” complaint for free-of-charge ambulance transport. Calls were deemed “pregnancy-related” if categorized by EMS dispatchers as “pregnancy”, “childbirth”, “miscarriage”, or “labor pains”. Interfacility transfers, patients absent upon ambulance arrival, and patients refusing care were excluded. Main outcome measures: Emergency medical technician (EMT) interventions, method of delivery, and death. Results: The median age enrolled was 23 years (IQR 21-25). Women were primarily from rural/tribal areas (1550/1684 (92.0%)) and lower economic strata (1177/1684 (69.9%)). Time from initial call to hospital arrival was longer for rural/tribal compared to urban patients (66 min (IQR 51-84) vs 56 min (IQR 42-73), respectively, p<0.0001). EMTs assisted delivery in 44 women, delivering the placenta in 33/44 (75%), performing transabdominal uterine massage in 29/33 (87.9%), and administering oxytocin in none (0%). There were 1411 recorded deliveries. Most women delivered at a hospital (1212/1411 (85.9%)), however 126/1411 (8.9%) delivered at home following hospital discharge. Follow-up rates at 48 hours, 7 days, and 42 days were 95.0%, 94.4%, and 94.1%, respectively. Four women died, all within 48 hours. The cesarean section rate was 8.2% (116/1411). On multivariate regression analysis, women transported to private hospitals versus government primary health centers were less likely to deliver by cesarean section (odds ratio 0.14 (0.05 to 0.43)). Conclusions: Pregnant women from vulnerable Indian populations use free-of-charge EMS for impending delivery, making it integral to the health care system. Future research and health system planning should focus on strengthening and expanding EMS as a component of EmONC.