A 25 year old primigravida with history of mitral stenosis and mitral regurgitation is in labour. She prefers a normal vaginal delivery. Which would be the best way to provide analgesia for this lady?

In pregnant patients with valvular hea disease there is significant stress on the cardiovascular system which leads to decompensation in previously asymptomatic individuals. During labour there is significant stress and inorder to reduce the pain and sympathetic stimulation, epidural anesthesia is preferred in such cases. In pregnant patients with mitral stenosis, mitral regurgitation, aoic stenosis or aoic regurgitation epidural anaesthesia is the preferred route during labour.