Labor pain relief is an important aspect of women's health that has historically been neglected. The only consistently effective method of labor pain relief, epidural analgesia, has recently undergone substantial improvements to address the concerns of both parturients and obstetric care providers. With increased physician awareness, the current low concentration epidural labor analgesic techniques are becoming widely accepted and are now routinely available for laboring parturients. This article provides a brief review of historical epidural analgesic practice and outlines recent advances that have culminated in the current ''state-of-the-art'' low-concentration epidural analgesic techniques. Protocols for the initiation, maintenance, and troubleshooting of low concentration epidural labor analgesia are provided as a guide to facilitate effective modern epidural labor analgesia. Copyright (C) 2001 by W.B. Saunders Company