Advances in the diagnosis of congenital defects have led to the development of a multidisciplinary approach to prenatal counseling and postnatal management. New techniques in fetal imaging, including magnetic resonance imaging (MRI), provide clinicians with better anatomic detail of such anomalies. This added information facilitates frank prenatal discussions with families, anticipating challenges in delivery room resuscitation and planning of postnatal care. In this report, we review three cases of giant omphalocele (GO) at our institution, highlighting the changes in practice management for prenatal diagnosis and consultation. We discuss controversies regarding mode of delivery and describe the evolution toward an initial nonsurgical approach to GO.