Obstetric anaesthesia is one of the high-risk areas of anaesthetic practice and is feared by many novices. Physiological differences of the pregnant patient are discussed.

The anaesthetist may have three main functions in the labour ward: provision of support and analgesia for the parturient, care of the patient in the obstetric theatre and care of the patients in the maternity high-dependency unit. Effective labour analgesia requiring the support of an anaesthetist may include the use of Entonox, IV/IM medications, and placement of an epidural or spinal. Remifentanil PCAs may be preferred in patients with contraindications to regional intervention and set-up may follow strict protocols and meticulous monitoring. A caesarean section may be an emergency depending on the threat to the health of the mother or fetus and may require urgent timely intervention. Regional anaesthesia is frequently the first choice, but some cases may require a general anaesthetic. Both types of interventions may carry risks and complications. Failed tracheal intubation in the obstetric patient should follow the OAA and DAS management guidelines.

Multiple pregnancy is associated with an increased risk of both maternal and foetal morbidity and mortality. A successful outcome requires a multidisciplinary approach involving obstetricians, neonatologists, obstetric anaesthetists, and midwives. The obstetric anaesthetist may be involved in antenatal assessment, care planning and counselling of parturients with multiple gestation. This is particularly important in pregnant women with medical comorbidities associated with special care needs and increased risk of perinatal complications or adverse outcomes. In twin vaginal delivery, effective epidural in labour is crucial not only for adequate analgesia but it may also increase the chances of successful delivery of the second twin. Providing safe and effective spinal anaesthesia, or general anaesthesia when indicated, for caesarean delivery is essential. A multimodal approach to postoperative analgesia enables enhanced recovery and early discharge after caesarean section. The role of the anaesthetist is crucial in managing critically ill pregnant women including those with pre-eclampsia and its complications. This chapter will cover the anaesthetist’s role in the context of multiple pregnancy.