Since 1990, there has been a huge change in the way regional analgesia is provided to mothers in labour. The main changes have been to improve the reliability of regional analgesia, while reducing motor block. In the UK, most anaesthetists initiate analgesia by the epidural route. There is growing support for the initial injection to be subarachnoid followed by epidural top-ups, using the technique of combined spinal-epidural (CSE).