A 28-year-old nullipara, paraplegic since birth, entered the hospital at 41 weeks' gestation in early labor. At 35 weeks, she had required treatment for a weeping decubitus ulcer. On admission, she was diaphoretic and anxious with BP of 210/105 mmHg, HR 100 beats/min, RR 24 breaths/min, and FHR 140 beats/min. The urine did not contain protein. After an IV preload, an epidural catheter was placed and 0.08% bupivacaine bolus injections begun. BP declined to 130/78 mmHg and anxiety resolved. The first stage lasted 6 h and was uneventful. One hour into the second stage, she was taken to the delivery room for an elective low-forceps delivery. The patient became anxious and diaphoretic again, her BP rose to 220/110 mmHg, and her upper extremities became hyper reflexic. IV labetalol 1 mg relieved the episode of autonomic hyperreflexia. The newborn had good Apgar scores and cord blood pH values.