We describe the intrapartum management of a patient with severe pulmonary hypertension using extradural analgesia with a low dose of 0.125% bupivacaine and fentanyl 20 micrograms ml-1 by continuous infusion at a rate of 2.5 ml h-1. This provided effective analgesia and haemodynamic stability. The importance of continuous direct measurement of pulmonary artery pressure is emphasized.