Epidural and spinal analgesia and labour

Epidural and spinal analgesia for pain relief in labour are now commonplace . Adverse effects such as hypotension and toxicity to anaesthetic agents ar e well described and easily managed. The effects on obstetric outcome, howe ver, have been unclear to both obstetricians and anaesthetists, but are imp ortant due to the large number of pregnancies involved. Efforts to define i mplications for mother and child have been frustrated by a relative lack of evidence derived from good quality, large randomized trials. Ethical and m ethodological difficulties together with an abundance of confounding factor s have conspired to cause considerable difficulties for researchers in this area. Nevertheless, recent evidence has significantly advanced knowledge i n the field and has implications for future practice.