Background: The global rise in caesarean section rates, especially in developing countries, poses significant challenges, with Pakistan witnessing an increase from 3.2% in 1990 to 19.6% in recent years. This trend surpasses the WHO’s recommended threshold and raises concerns about maternal morbidity and healthcare system efficiency. Objective: To determine fetomaternal outcomes and patient satisfaction rates associated with the use of the Labor Care Guide (LCG) in a tertiary care hospital setting. Material and Methods: This comparative cross-sectional study was conducted in the Obstetrics & Gynecology Ward Unit II at PUMHS over six months from October 2023 to April 2024. A total of 100 low-risk pregnant women were recruited using a consecutive non-probability sampling technique and divided into two equal groups: Group I (LCG) and Group II (Modified Partograph). Inclusion criteria encompassed women aged 18 to 40 years with spontaneous labor at an active phase, while those with induced labor or complications were excluded. Data collection involved comprehensive maternal assessments, physical examinations, and labor monitoring using the respective guides. Statistical analysis was performed using SPSS version 25, with p-values <0.05 considered significant. Results: Group I had a higher percentage of multi-para women (54%) compared to Group II (44%), though this was not significant (p > 0.05). Vaginal delivery was more common in Group II (62%) than in Group I (54%), while cesarean section rates were comparable (38% in Group I and 34% in Group II). Notably, fetal distress was a significant indication for cesarean sections in Group I (16%) compared to Group II (7.8%, p = 0.003). The incidence of postpartum hemorrhage (PPH) was 10% in Group I and 14% in Group II (p > 0.05). NICU admissions were higher in Group II (30%) than in Group I (14%), with a significant association for meconium aspiration (p = 0.04).