An increasing number of women receive epidurals during labor and birth. Although the incidence of adverse reactions remains very low, the potential for life-threatening complications still exists. The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) states that the safety of women undergoing procedures, such as the administration of epidural analgesia/anesthesia, depends significantly on the competence, attentiveness, and experience of those responsible for their care. The purpose of this article is to review the significant complications related to obstetric epidural. Recommendations are presented to aid the nurse in preparing for and managing epidural emergencies. Specific responsibilities of nurse managers and educators in competency training, evaluation, and guidance of nurses are also discussed.