Background: Labour analgesia has rapidly gained popularity in obstetric practice. Low usage in the developing world has raised concern. Objectives: To assess the knowledge, attitude and use of labour pain relief methods in women attending antenatal clinic in Nairobi. Design: A prospective study. Setting: Aga Khan University Hospital, a teaching and referral hospital in Nairobi, Kenya. Subjects: Two hundred and two consecutive expectant mothers attending antenatal clinic at the Aga Khan University Hospital, Nairobi. Results: Fifty six per cent of the participants had knowledge about labour pain relief methods. Friends, the antenatal clinic and books/leaflets were the major source on information. Ninety per cent indicated they would intend to have some form of labour pain relief at their next delivery. Eighteen percent had been offered some form of pain relief at their last delivery with 82% of those offered having effective pain relief (P< 0.001). Conclusions: While most of our participants were well educated, level of knowledge of labour analgesia is still low. Use of labour analgesia is also still quite low in comparison to the western World. It is recommended that obstetricians and anaesthetists participate in knowledge dissemination and setup of dedicated labour analgesia services in this region.