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Background: Primigravida women experience increased labor pain and emotional distress. Midwife-led continues labor support offers emotional benefits and reduces maternal and newborn complications; however, its effects on primigravidas’ labor pain, satisfaction, and newborn admissions has not been studied in Ethiopia. Objective: This study aimed to evaluate the effect of midwife-led continuous labor support on primigravida women's labor pain, satisfaction, and newborn admission rates. Methods: A quasi-experimental study compared midwife-led continuous labor support with routine care among 419 primigravida women at four Ethiopian hospitals (two intervention, two control). Data were collected from July to December 2024 through interviews and records. Senior midwives and the principal investigator trained all midwives at the intervention sites, as well as two additional midwives for overload periods. Support averaged 90 min per woman. Fisher's Exact test e assed changes (P < 0.05). Results: Midwife-led continuous labour support increased maternal satisfaction among primigravida women from 147 (71.4%) in the control group to 167 (78.4%) in the intervention group, a net increase of 7% (P < 0.001). It reduced pain from 136 (66%) to 98 (46%), a net decrease of 20% (P < 0.037). Neonatal intensive care unit admissions decreased from 23 (11.2%) to 12 (5.6%), a net reduction of 6.6% (P < 0.004). There was no effect on newborn death rates. Conclusions: Midwife-led support effectively reduced pain, increased satisfaction, and decreased NICU admission for primigravida women in Ethiopia through continues psychological and physical support, improving maternal and newborn wellbeing. Implementing this approach facility-wide and evaluate sustainability in routine care is necessary. © 2026 The Authors. Published by Elsevier B.V. on behalf of INDIACLEN. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/