Background: Understanding the implications of maternal oxygenation during elective cesarean sections with spinal anesthesia on neonatal outcomes is crucial for optimizing perinatal care. This study aimed to determine the effect of maternal oxygenation on neonatal outcome in full term elective cesarean section under spinal anesthesia. Methods: This randomized controlled trial, conducted from June to December 2022 at Benha University Hospital, included pregnant patients beyond 37 weeks of gestation undergoing elective cesarean section. Participants were divided into two groups: Group A received oxygen supplementation, while Group B did not. Various assessments, including maternal and neonatal parameters, were conducted. Results: Group A exhibited significantly higher maternal oxygen levels (100 ± 0 vs. 95 ± 1, P < 0.001). Neonates in Group A demonstrated lower umbilical vein carbon dioxide (35.3 ± 6.4 vs. 39.4 ± 7.8, P = 0.013) and bicarbonate levels (19.3 ± 2.7 vs. 21.6 ± 5.3, P = 0.019) but higher oxygen levels (34 ± 6 vs. 22 ± 4, P < 0.001). Apgar scores were higher in Group A at 1 minute (median = 9 vs. 8, P = 0.023), 10 minutes (median = 10 vs. 9, P < 0.001), and 20 minutes. Group A neonates also had significantly higher oxygen levels at 1, 3, 5, and 10 minutes post-delivery but there was no statistically significant difference in admission rate. Conclusion: Maternal oxygenation during elective cesarean sections may positively influences neonatal outcomes, as evidenced by improved Apgar scores and higher neonatal oxygen levels but no effect on admission rate.