Multiple pregnancy is associated with an increased risk of both maternal and foetal morbidity and mortality. A successful outcome requires a multidisciplinary approach involving obstetricians, neonatologists, obstetric anaesthetists, and midwives. The obstetric anaesthetist may be involved in antenatal assessment, care planning and counselling of parturients with multiple gestation. This is particularly important in pregnant women with medical comorbidities associated with special care needs and increased risk of perinatal complications or adverse outcomes. In twin vaginal delivery, effective epidural in labour is crucial not only for adequate analgesia but it may also increase the chances of successful delivery of the second twin. Providing safe and effective spinal anaesthesia, or general anaesthesia when indicated, for caesarean delivery is essential. A multimodal approach to postoperative analgesia enables enhanced recovery and early discharge after caesarean section. The role of the anaesthetist is crucial in managing critically ill pregnant women including those with pre-eclampsia and its complications. This chapter will cover the anaesthetist’s role in the context of multiple pregnancy.