Obstetric anesthesia is a demanding subspecialty of anesthesiology. The challenges presented by a parturient requiring anesthesia or analgesia, or both, make the role of the obstetric anesthesiologist both challenging and rewarding. Those providing anesthetic services to the labor and delivery suite must be familiar with the unique physiology of the parturient and the effects of numerous drugs and techniques on the parturient and fetus. The widespread acceptance and use of regional anesthesia for labor has made obstetric anesthesia a major part of most anesthetic practices. Continuous improvements in drugs and techniques have led to a significant decrease in anesthetic-related deaths in the delivery suite. Newer advances include introduction of newer techniques like combined spinal epidural anesthesia, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anesthetics ropivacaine, levobupivacaine and adjuvants like sufentanil, use of inhalational agents like sevoflourane for patient controlled inhalational analgesia using special vaporizers. Technological advances like use of ultrasound to localize epidural space in difficult cases all have revolutionized the practice of pain management in labouring parturients. However, there will always remain a place for general anesthesia, first, in cases where regional anesthesia is contraindicated and in emergencies; second where the anesthetist feels more confident using general anesthesia; and third, when the patient expresses a strong preference to be asleep. Maternal outcome is better with regional anesthesia than with general anesthesia.