This population-based study in Scotland examined the effect of labor epidural analgesia on severe maternal morbidity (SMM) and explored whether this effect was more pronounced in women with medical indications for epidural analgesia or those delivering preterm. The study included 567,216 women in labor between 24+0 and 42+6 weeks' gestation, of whom 125,024 received epidural analgesia. The primary outcome, SMM, was defined as the presence of at least one of 21 conditions used by the US Centers for Disease Control and Prevention (CDC) as criteria for SMM, or critical care admission, occurring from the date of delivery to 42 days postpartum. The results showed that epidural analgesia was associated with a 35% reduction in SMM (adjusted relative risk 0.65, 95% CI 0.50 to 0.85), a 54% reduction in SMM plus critical care admission (0.46, 0.29 to 0.73), and a 42% reduction in respiratory morbidity (0.42, 0.16 to 1.15). The greatest risk reductions were observed in women with medical indications for epidural analgesia (0.50, 0.34 to 0.72) and those delivering preterm (0.53, 0.37 to 0.76). The study concluded that epidural analgesia during labor could significantly reduce SMM, particularly in high-risk women, and suggested that expanding access to epidural analgesia could improve maternal health outcomes.This population-based study in Scotland examined the effect of labor epidural analgesia on severe maternal morbidity (SMM) and explored whether this effect was more pronounced in women with medical indications for epidural analgesia or those delivering preterm. The study included 567,216 women in labor between 24+0 and 42+6 weeks' gestation, of whom 125,024 received epidural analgesia. The primary outcome, SMM, was defined as the presence of at least one of 21 conditions used by the US Centers for Disease Control and Prevention (CDC) as criteria for SMM, or critical care admission, occurring from the date of delivery to 42 days postpartum. The results showed that epidural analgesia was associated with a 35% reduction in SMM (adjusted relative risk 0.65, 95% CI 0.50 to 0.85), a 54% reduction in SMM plus critical care admission (0.46, 0.29 to 0.73), and a 42% reduction in respiratory morbidity (0.42, 0.16 to 1.15). The greatest risk reductions were observed in women with medical indications for epidural analgesia (0.50, 0.34 to 0.72) and those delivering preterm (0.53, 0.37 to 0.76). The study concluded that epidural analgesia during labor could significantly reduce SMM, particularly in high-risk women, and suggested that expanding access to epidural analgesia could improve maternal health outcomes.