This chapter deals with methods of analgesia and anaesthesia for operative vaginal birth (OVB). It describes the various types of analgesia and anaesthesia used in different situations. Local anaesthesia has the advantages of wide availability and low cost. It is administered by the obstetrician attending the woman: an anaesthetist does not need to be available at the time. Local anaesthetics are reversible membrane stabilising drugs; they block the sodium channels in the nerve membrane, preventing depolarisation and transmission of nerve impulses. A pudendal block is generally a safe procedure with few complications. The risk of needlestick injury in the course of this blind procedure should be minimised by gaining familiarity with the instrument. Neuraxial regional blockade is effected by injection of local anaesthetic and/or opioid into the epidural and/or subarachnoid spaces, blocking sensory nerves as they enter the spinal cord.