Abstract Background: Neuraxial analgesia is the gold standard for conducting painless labor either by epidural route or combined spinal epidural. Aim of Study: This study is to evaluate the effect of adding neostigmine to levobupivacaine for epidural labor analgesia on mother and neonate. Patient and Methods: After approval from local ethical committee and obtaining written informed consent this pro-spective randomized double-blind study was conducted on 60 laboring mothers, aged between 21 to 38 years, ASA I & II, single pregnancy, gestational age >!37 weeks in active cervical dilatation (!95cm) subjected to normal labor by epidural analgesia. Parturient were randomly divided into two groups: Group L (n=30): Received 15ml of 0.125% levobupivacaine. Group N (n=30): Received 15ml of 0.125% levobupivacaine + 6mic/kg neostigmine. Onset of sensory block, duration of analgesia, maternal hemodynamics, motor block and total dose of levobupivacaine were recorded. Maternal outcome in the form of (duration of labor, mode of delivery), Apgar score at (1 and 5min) and side effects were also recorded. Results: There was faster onset of sensory block and prolonged duration of analgesia with neostigmine group compared with other group. No significant difference between both groups as regard hemodynamics. No motor blockade in both groups. There was significant reduction in the total dose of levobupivacaine with neostigmine group. There was shorter duration of labor with neostigmine group. No significant difference as regard mode of delivery, Apgar score and com-plications between the two groups. Conclusion: Neostigmine can be utilized as a safe adjuvant with levobupivacaine to provide a better quality of analgesia and reduce dose of local anesthetic during management of labor pain. Also it's safe for both mother and fetus.