Multiple gestations account for approximately 1 in 150 births and are commonly associated with two complications: breech presentation and prematurity. Anesthesia may be necessary for version, extraction, or cesarean section. The second baby (and any subse-quent ones) is often more depressed and asphyxiated than the first. Regional anesthesia provides effective pain relief during labor, minimizes the need for cen-tral nervous system depressants, and may shorten the interval between the birth of the first and second baby. Some studies suggest that the acid–base status of the second twin is better when epidural anesthe-sia is used. Patients with multiple gestations, how-ever, are more prone to develop hypotension from aortocaval compression, particularly after regional anesthesia.