Obesity is a major health problem in the developed world and is beginning to have an impact on pregnancy (CEMACH 2004). We aimed to examine the differences in the intra-partum care of morbidly obese women compared with those of normal weight women. Intra-partum variables of labour monitoring as well as anaesthetic and neonatal variables were compared between 50 morbidly obese and 50 normal weight women. The morbidly obese group was observed to be significantly more prone to invasive fetal monitoring (27% vs 0%, p <or= 0.001), difficult uterine contraction monitoring (30% vs 0%, p <or= 0.001), more medical personnel involvement (22% vs 2%, p = 0.007). They were also found to be more likely to experience multiple epidural attempts (28% vs 0%, p<0.001), complications in labour (32% vs 6%, p < 0.001) and paediatric involvement (26% vs 3%, OR for 95% confidence interval is 1.5-20.8). There were no significant differences in the demographic variables, such as age, parity, gestational age and birth weight. Morbidly obese women are at significantly increased risk of complications during the intra-partum period, and require more intervention leading to increased morbidity and cost. Guidelines are needed for the intra-partum management of the morbidly obese pregnant woman to reduce the risk of morbidity and mortality.