Background: Labor pain is a physiologic pain that encountered during uterine contractions of childbirth. Neglected labor pain has various complications for both mother and her fetus. Lack of awareness and negative attitude to labor analgesia are the main problem to reduce labour pain and improve normal outcomes. The aim of study was to assess awareness; attitude and associated factors of labor analgesia among pregnant women visited the antenatal care facility at xx referral hospital. Methods: An institutional based cross-sectional study was conducted. Participants were selected by systematic random sampling technique and the data were collected using semi-structured questionnaires. Data was entered in to EPI info version 7 and transferred to SPSS version 20 computer program for analysis. Bivariate and multivariable logistic regression was computed to identify factors associated with awareness and attitude towards labor analgesia. Independent variables with P-value less than 0.2 were selected for multivariable logistic regression. On the multivariable logistic regression, a p-value of <0.05 was used to declare statistical significance. Results: A total of 310 pregnant women with response rate of 95.7% were participated in this study. Nearly thirty five percent, (34.5%) of participants had information about labour analgesia. Approximately 40.3% of participants had positive attitude to labour analgesia. However, 27.3% pregnant women did not want to receive labour analgesia and 36.6% of participants believed that labor pain is natural event. Being urban in residency and previous vaginal delivery showed significant association with awareness towards labor analgesia (AOR = 3.3, 95% CI (1.22–9.08)) and (AOR = 0.64, 95% CI (0.48–0.87)) respectively. On the other hand, education level showed statistically significant association with positive attitude towards labor analgesia (AOR = 0.1, 95% CI (0.04–0.24). Conclusion: The awareness and attitude of the study participants towards labor analgesia were found to be low. Pregnant women's residence, educational status and vaginal delivery were associated with awareness of labor analgesia. Highlights