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Crohn’s disease is often diagnosed in women of reproductive age. These women have fewer children than the general population, due to sexual dysfunction (especially in cases of perineal disease) and reduced fertility, as well as voluntary childlessness related to concerns about disease transmission to the offspring and the side effects of treatment. Preconception counselling, therefore, is crucial to inform and counter misconceptions about pregnancy and allowable medications, and to help choose the mode of obstetric delivery, and it should be offered to all women with Crohn’s disease (CD) planning a pregnancy. Most CD medications are compatible with pregnancy (including TNF inhibitors, ustekinumab, and vedolizumab) and should be continued throughout pregnancy to maintain disease remission. The choice of delivery method should be primarily guided by obstetrical considerations, then adjusted based on gastroenterological factors. Most patients with CD without any perineal disease can have a safe vaginal delivery, without worsening of fecal incontinence, new perineal tears, or disease flare-ups. Planned cesarean delivery may, however, be recommended too often for these patients. The three mandatory indications for C-section delivery (according to the 2023 ECCO guidelines, albeit with low evidence) are active perineal disease, the presence of an ileoanal anastomosis, or an ano/recto-vaginal fistula. For women with inactive perineal disease, the choice of delivery method must be discussed early, in collaboration with the obstetrician, the gastroenterologist, and the proctologist, taking into account the severity of perineal disease, fecal incontinence, previous surgeries, sphincter injuries, and previous pregnancies. A proctological evaluation, including anal endosonography and anorectal manometry, is often needed to assist in decision-making.