Globally, many women and newborn die or develop long-term disabilities due to complication of labour and delivery. Second stage admission is more often associated with maternal and fetal morbidity and mortality. The aim of this study was to compare the fetal outcomes among mothers presenting in first Stage of labour and those that present in the second stage of labour at Kakamega county Referral hospital. A quantitative, cross sectional study was conducted. Systematic sampling technique was used to recruit the participants. Data was collected using a pre-tested structured questionnaire administered to 640 mothers in labour; half in first stage and another half in second stage of labor.Data was coded and analyzed using Statistical Package for Social Sciences (SPSS) version 20. Chi-square test and multiple logistic regressions were employed in the analysis. A p < 0.05 was considered significant at 95% confidence interval. Null hypothesis was tested at 5% significance level. The study revealed that mothers presenting in first stage of labour had higher chances of normal labour compared to those presenting in second stage of labour (df=1, χ2 =46, p<0.0001). Most of neonates born by mothers who presented in second stage of labour had low apgar score and were admitted to NBU (15.6%) compared with 1.6% of neonates born to mothers who were admitted in first stage of labour. In conclusion the study found out that most of mothers presenting in second stage of labour were primary school leavers and housewives with no formal employment. Majority of mothers who presented in first stage had normal labor, gave birth to normal neonates with an APGAR score above 7 compared as opposed to thos e who presented in second stage of labour. For the wellbeing of the neonates and mothers, labour needs to be monitored and delivery conducted by skilled personnel. Therefore, mothers should be sensitized during antenatal visit on birth preparedness and importance of presenting to hospital in first stage of labour for delivery.