The use of paracervical, pudendal, and caudal anesthesia in the obstetric population has declined over the past 30 years. However, each technique offers the unique advantage for regional anesthesia when central axial blockade is not possible or when obstetric anesthesia services are not available. Paracervical blockade inhibits pain arising from cervical dilation and uterine contractions; therefore, it is useful to relieve the pain of the first stage of labor or to provide anesthesia for postpartum dilation and curettage. The major limitation of this technique is the potential for fetal bradycardias after local anesthesia injection; therefore, it may be most useful when the fetus is not a consideration (eg, stillbirth in pregnancy). Pudendal nerve blockade provides anesthesia for the lower vagina and perineum, which is most commonly used during the second stage of labor. This block is useful for low-outlet, operative vaginal deliveries or for postpartum perineal trauma repairs. The caudal block provides epidural anesthesia of the sacral roots, although large local-anesthetic volumes anesthetize the thoracic and lumbar levels. Currently, the most favored technique of caudal anesthesia is a single-shot bolus of local anesthesia because it provides profound and expedient saddle block anesthesia/analgesia. Both anesthesiologists and delivering health care providers should be aware of these alternatives for their obstetric patients. Copyright © 2001 by W.B. Saunders Company