Objective To compare the analgesic effect of ropivacaine combined with nalbuphine and ropivacaine combined with fentanyl in epidural labor analgesia, the adverse reactions and the effect on Apgar score of newborns. Methods Six hundred and sixty⁃two full‑term primiparas [American Society Anesthesiologists (ASA) grade Ⅰ or Ⅱ] requesting epidural labor analgesia were randomly divided into two groups using an online random number generator: a combination of ropivacaine with nalbuphine group (0.1% ropivacaine+0.2 g/L nalbuphine, RN group, n=333) and a combination of ropivacaine with fentanyl group (0.1% ropivacaine+2 mg/L fentanyl, RF group, n=329). Numerical Rating Scale (NRS) of pain, satisfaction scores of primiparas and midwives, side effects of pregnant women and Apgar scores of newborns were recorded during the whole labor process. Results A total of 547 participants completed the study, with 276 and 271 women in group RN and RF, respectively. NRS in the RN group was significantly lower than the score in the RF group during the first stage of labor whereas there was no significant difference in the NRS between the two groups during the second stage of labor. The proportion of urinary retention during labor in the RN group (17.75%) was significantly lower than the proportion in the RF group (30.26%)(P<0.05). No significant difference was observed in the incidence of nausea, vomiting, pruritus, Bromage score>0 and the ratio of newborns with Apgar score≤7 at 1 min and 5 min between the two groups (P>0.05). Conclusions Compared with ropivacaine combined with fentanyl, ropivacaine combined with nalbuphine is more effective in epidural labor analgesia, with fewer adverse reactions, and has no significant effect on Apgar score of newborns.