text: Whats New in Neuraxial Labor Analgesia This article provides an update of recent practice trends in neuraxial labor analgesia It reviews available evidence regarding management of labor pain in obstetric patients with COVID 19 serious adverse events in obstetric anesthesia to help inform risk benefit decisions and increasingly popular neuraxial labor analgesia techniques and adjuvants State of the art modes of epidural drug delivery are also discussed There has recently been a focus on several considerations specific to obstetric anesthesia such as anesthetic management of obstetric patients with COVID 19 platelet thresholds for the safe performance of neuraxial analgesia in obstetric patients with thrombocytopenia and drug delivery modes for initiation and maintenance of neuraxial labor analgesia Neuraxial labor analgesia via standard epidural dural puncture epidural and combined spinal epidural techniques is the most effective therapy to alleviate the pain of childbirth SARS CoV 2 infection is not in and of itself a contraindication to neuraxial labor analgesia or cesarean delivery anesthesia Early initiation of neuraxial labor analgesia in patients with COVID 19 is recommended if not otherwise contraindicated as it may reduce the need for general anesthesia should emergency cesarean delivery become necessary Consensus regarding platelet thresholds for safe initiation of neuraxial procedures has historically been lacking Recent studies have concluded that the risk of spinal epidural hematoma formation after neuraxial procedures is likely low at or above an imprecise range of platelet count of 70 75 000 10 sup 6 sup L Thrombocytopenia has been reported in obstetric patients with COVID 19 but severe thrombocytopenia precluding initiation of neuraxial anesthesia is extremely rare High neuraxial blockade has emerged as one of the most common serious complications of neuraxial analgesia and anesthesia in obstetric patients Growing awareness of factors that contribute to failed conversion of epidural labor analgesia to cesarean delivery anesthesia may help avoid the risks associated with performance of repeat neuraxial techniques and induction of general anesthesia after failed epidural blockade Dural puncture techniques to alleviate the pain of childbirth continue to become more popular as do adjuvant drugs to enhance or prolong neuraxial analgesia Novel techniques for epidural drug delivery have become more widely disseminated 