ABSTRACT: The fetus is capable of producing catecholamines from early in gestation. Normal concentrations of these compounds are necessary for fetal and neonatal homeostasis, and for successfully completing the transition from fetal to neonatal life. Fetal and neonatal stress result in marked elevations of catecholamine levels, causing a large number of physiologic derangements. While fetal catecholamines are endogenously produced, maternal illness and anxiety can initiate the chain of maternal catecholamine production, causing dysfunctional labor and uterine hypoperfusion, and through this mechanism, fetal distress. Measures to reduce maternal anxiety should have a high priority in the management of labor. While nonpharmacologic methods may suffice, the use of analgesic agents in moderate doses may be protective to the fetus in selected circumstances.