Although use of epidural analgesia during labor is safe, detailed information about its association with neonatal and child outcomes is limited.

We investigate the association of labor epidural analgesia with neonatal outcomes and childhood development during the first 1000 days of life.

This population-based cohort study used Scottish National Health Service hospital administrative data of all 435 281 singleton live births in Scotland between January 1, 2007, and December 31, 2016, with follow-up over the first 1000 days of life.

All 435 281 mother-infant pairs delivering between 24 weeks 0 days and 43 weeks 6 days’ gestation who were in active labor with cephalic presentation and who delivered vaginally or via unplanned cesarean delivery were included.

Stillbirths and infants with known congenital anomalies were excluded. Data were analyzed between August 1, 2020, and July 23, 2021.

Neonatal outcomes included resuscitation, Apgar score less than 7 at 5 minutes, and neonatal unit admission.

Childhood development measures (gross and fine motor function, communication, and social functioning) were obtained from standardized national childhood surveillance assessments performed at 2 years