Inspiration
The piano playing on this song was inspired by 1950s rock/blues pianist, Fats Domino. McCartney recalled in 1994, "'Lady Madonna' was me sitting down at the piano trying to write a bluesy boogie-woogie thing ... It reminded me of Fats Domino for some reason, so I started singing a Fats Domino impression. It took my voice to a very odd place. " Domino himself would cover the song later in 1968, and it would become his most recent U.S. Hot 100 hit (peaking at exactly #100). The song and in particular the introduction are similar to Humphrey Lyttelton's "Bad Penny Blues" from 1956. John Lennon helped write the lyrics. The line "see how they run" was included after his suggestion (and was a theme that had been used in the previous year's "I Am the Walrus").

Recording
"Lady Madonna" is a song by The Beatles credited to Lennon/McCartney. In March 1968, it was released as a single, backed with "The Inner Light". The song was recorded at Abbey Road Studios during sessions on 3 February and 6 February 1968 before the Beatles left for India. This single was the last release by the band on Parlophone in the UK, where it reached number one, and Capitol Records in the U.S., where it reached number four. All subsequent releases, starting with "Hey Jude" in August 1968, were released on their own label Apple Records, under EMI distribution, until the late 1970s, when Capitol and Parlophone re-released old material.
The saxophone solo was played by British jazz musician and club owner Ronnie Scott. The mix used in the single had much of Scott's saxophone playing removed, but the versions on Anthology 2 and Love feature a more prominent use of Ronnie's solo, at the end of the song. In a BBC documentary, Timewatch, McCartney explained the decision behind this saying that at the time, Scott had not been impressed that his music had been hidden behind other instruments, so McCartney had decided to fix it with the most recent mix.

Promotional Films
Two promotional films were made for Lady Madonna, which were syndicated to television broadcasting companies. The material was shot on 11 February 1968 in Abbey Road Studios, and was distributed by NEMS Enterprises to US and UK TV stations. The footage consisted of The Beatles recording in the studio. The song they were working on at the time was Hey Bulldog. In 1999 the material was re-edited by Apple to create a new promo for Hey Bulldog.

Love Version
A remixed version of this song was featured in the Cirque du Soleil show LOVE. In this form, the saxophone solo is played almost un-accompanied at the very beginning of the song. The drum intro to "Why Don't We Do It In the Road" can be heard at the beginning. After the first two verses, it changes to the riff from "Hey Bulldog" in A minor, with a remixed version of the Hammond Organ solo from "I Want You (She's So Heavy)" and parts of Eric Clapton's guitar solo from "While My Guitar Gently Weeps". It then returns to the original form of the song, and at the very end a saxophone solo outro is played.