This article is a case report of a spontaneous vaginal delivery of live triplets, which included conjoined twins joined at the buttocks. The birth was conducted by an experienced midwife in a rural maternity in the Anambra State of Nigeria. The case illustrates the difficulties faced by rural Nigerian midwives when patients need referral to larger hospitals. There is a scarcity of diagnostic equipment, medical back-up, and the transportation that could facilitate an effective referral network. In addition, patients are reluctant to leave their home villages to give birth in a far-away hospital. For these reasons, many difficult births take place in rural maternity centers. The successful outcome of this high-risk delivery demonstrates the skill of the local Nigerian midwife, who is frequently faced with unusual complications of childbirth, ones that she must resolve herself.