Background & Objectives: Remifentanil as a potent ultra short opioid agonist, rapidly metabolized in mother and fetus is becoming more and more popular in labor analgesia as alternative to neuroaxial analgesia. Recent studies comparing epidural with remifentanil analgesia showed us much better pain relieve scores in epidural analgesia; however there was no big difference in satisfaction scores in both groups. In this study, we compared maternal and neonatal side effects, as well as patient satisfaction. Materials & Methods: We analyzed 55 patients, ASA I, at term admitted for spontaneous labor and divided into two groups. The first group (30 patients) received continuous epidural infusion (0.1% Bupivacain and Fentanyl 2 μg/ml) 10 ml/h beginning immediately after the initial dose. The second group (25 patients) received iPCA with remifentanil titrated from 20 mcg up to a maximum bolus dose of 50 mcg with a lockout interval of 2 minutes. Our primary outcome was maternal and neonatal safety. We evaluate pulse oximetry (SpO2), heart rate, respiratory rate, sedation scores, Apgar scores and umbilical cord blood gas analysis. Supplementary oxygen was administered continuously during the respiratory monitoring period. The secondary outcome was efficacy evaluated through hourly pain scores and satisfaction scores (two different 10 point Visual Analoge Scales). Results: Mean SpO2 was lower in the remifentanil group 96.4% vs 98.2 for epidural group. No respiratory depression (respiration rate <9 or SpO2 <90%) was found in both groups. The Ramsay sedation scores were significantly higher in the remifentanil group, P < 0.0001. Apgar scores and neonatal respiratory outcomes were similar. As expected, remifentanil was inferior to epidural analgesia with respect to the pain scores at all time points, P < 0.0001. No significant difference between the two groups in maternal satisfaction (8.9 for the remifentanil group and 9.1 for the epidural group). Conclusion: IPCA with remifentanil provides satisfactory level of labor analgesia, with lower SpO2 and more sedation. It can be a viable alternative to epidural analgesia, but continuous monitoring and oxygen supply is mandatory.