A healthy 33-year-old primiparous woman developed sudden central, nonradiating chest pain and right-sided neck and facial swelling during a prolonged second stage of labor. The main finding was subcutaneous emphysema involving the neck and face. Spontaneous pneumomediastinum (SPM) is a rare cause of chest pain and can lead to subcutaneous emphysema during labor. It is probable that SPM occurred during the second stage, due to prolonged and strenuous valsalva maneuvers. Subcutaneous emphysema can accumulate, enlarge, and cause upper-airway obstruction in the neck.