Introduction: In India's immense population, the maternal mortality ratio in 2016–2018 was 113. We are still away from the sustainable development goals (SDGs) of MMR less than 70 per 100,000 live births set by the United Nations.¹ In obstetric patients, due to the occasional occurrence of critical conditions, it is hard to identify the initial signs of grievous illness. Focusing on mothers whose comorbidities place them at risk of severe maternal morbidity is a strategy for risk reduction. The obstetric comorbidity index (OB-CMI) is one such tool that summarizes the burden of maternal comorbidities with a quantified approach. Aim: To evaluate the performance of OB-CMI in identifying women at risk of severe maternal morbidity (SMM) during labor. Material and methods: We did a retrospective analysis of hospital records of pregnant women >28 weeks gestation admitted to the labor room, in labor, or planned for delivery (January–June 2019). On admission, the OB-CMI was calculated for each patient based on history, examination, and investigations. Any SMM (ACOG and Society for Maternal-Fetal Medicine consensus definition) experienced before discharge was recorded. Association between OB-CMI and SMM was analyzed. Results: Out of the 1678 women included in the study, 36 women experienced SMM (2.1%). The OB-CMI ranged from 0 to 10, with a median of 0. The median of patients experiencing SMM was 5 as compared to 0 in those who did not (p <0.000). For every 1-point increase in the score, patients experienced a 2.02 increase in odds of severe maternal morbidity (95% confidence interval, 1.75–2.34). The ROC analysis revealed good discrimination between OB-CMI and SMM (0.841, 95% confidence interval 0.752–0.930). Conclusion: The prevention of SMM is a priority and OB-CMI is a clinically valid tool to identify women at risk during delivery. It is useful as a screening tool, for triaging high-risk patients in specialized institutions that are well equipped. It could also complement physiologic-based screening tools and help in early intervention.