Women with severe pre-eclampsia (PE) commonly require delivery by Caesarean section (CS). Whilst the choice of anaesthetic technique in this group of women has been controversial for a number of years, clinical experience has demonstrated the relative safety and value of well-managed incremental epidural anaesthesia. Several studies attest to the benefits of epidural analgesia in labour and epidural anaesthesia for CS. It is now widely recognised that epidurals provide relatively smooth control of blood pressure, maintain or improve utero-placental perfusion, optimising fetal outcome, and eliminate the airway and haemodynamic problems associated with general anaesthesia. Thus, epidural anaesthesia is the current technique of choice amongst most obstetric anaesthetists for CS in severe PE. Good inter-disciplinary communication between anaesthetic and obstetric staff should allow the need for CS to be anticipated early, and the epidural catheter inserted and topped-up in good time. However, in the case of urgent CS where it is not considered appropriate to wait the time required to produce effective epidural blockade, the choice of technique lies between spinal and general anaesthesia.