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Epidurals remain the gold standard for labour analgesia, especially during the current COVID-19 pandemic. They provide superior analgesia and lower the physiological and chemical responses to labour stress. However, they are associated with higher rates of instrumental delivery, maternal pyrexia and hypotension. Less invasive substitutes include nitrous oxide and parenteral opioids such as patient-controlled analgesia (PCA) with remifentanil. Non-pharmacological methods include hypobirthing and relaxation techniques, giving the mother a less medicalised labour experience. Newer regional techniques such as erector spinae and quadratus lumborum blocks are promising alternatives in those who cannot have or do not want an epidural. This review will outline the indications and contraindications to labour epidural use, and potential alternatives to an epidural.