This chapter begins with a discussion on the pharmacology of both new and accepted drugs in obstetric anesthesia management. Drugs administered to the parturient to provide analgesia or anesthesia for childbirth can affect not only maternal physiology but also fetal condition and neonatal well-being. Therapeutic strategies must be formulated with consideration for these effects, as well as the compounding influences of obstetric agents and illicitly consumed substances. Operative anesthesia must be appropriately adapted to the special requirements of surgery during pregnancy but is rarely a legitimate alternative for analgesic management. An obstetric anesthesia service requires a director with interest and skill in management; clinical, educational, or research success is not a substitute. Challenges include provision for appropriate staffing and equipment and fostering effective communication among professional staff from multiple disciplines whose timely, coordinated input is essential to safe, high-quality outcomes.