A new chapter, developed from the previous Anaesthetic chapter in the previous Edition. Clear explanations of local anaesthetic systemic toxicity, recognition and management of this rare but life-threatening complication that can occur in maternity care. Key learning points: Local anaesthetic systemic toxicity (LAST) is an emergency that can evolve rapidly. LAST requires a multi-professional team to deliver life-saving treatment. Women may receive local anaesthetic via multiple routes during labour (epidural, other nerve blocks and injections) and this may have a cumulative effect on increasing plasma concentrations. LAST can mimic other high-risk conditions in pregnancy (e.g. eclampsia) and should be considered as a differential diagnosis whenever local anaesthetics have been given. Pregnant women should be given information so that they can report symptoms early, and all maternity staff should be aware of the initial warning signs. Early recognition and timely administration of lipid emulsion (e.g. Intralipid®) are crucial. All maternity staff should know where lipid emulsion is kept in their department. Cardiac arrest secondary to LAST can be prolonged; good quality CPR should be maintained throughout.