Postdural puncture headache (PDPH) is the most common serious complication in obstetric anesthesia. We show the incidence of accidental dural puncture (ADP), PDPH, epidural blood patch (EBP) and associated morbidity following a protocol established in an obstetric anesthesia department. An observational, prospective, analytical study performed in 66,540 epidural labor analgesia procedures. The objective is to describe the incidence of ADP, PDPH and EBP in a large obstetric anesthesia population, as well as morbidity associated with ADP and EBP. Incidence of ADP and PDPH was 0.76% and 59%, respectively, and the global incidence of EBP was 0.2%. Experience of the anesthetist performing the epidural (1st or 2nd year resident) and night shift were correlated with ADP. Low back pain was more frequent in patients undergoing EBP. We found an incidence of ADP and PDPH of 0.76% and 59%, respectively. Experience of the anesthetist performing the epidural (1st or 2nd year resident) and night shift were correlated with ADP. EBP is a safe, easy and acceptable treatment for PDPH, despite a higher risk of low back pain.