Introduction: The choice between spinal and general anesthesia during cesarean section can influence neonatal outcomes, particularly Apgar scores. Evidence suggests that spinal anesthesia may lead to better immediate neonatal health indicators. Aim of the Research: This study aimed to compare the effects of spinal versus general anesthesia on neonatal Apgar scores following cesarean delivery and to examine associated maternal and neonatal outcomes. Methods: A quasi-experimental comparative study was conducted involving 50 women undergoing cesarean section, evenly assigned to either spinal or general anesthesia groups. Data were collected on maternal demographics, anesthesia procedures, and neonatal outcomes. Apgar scores were assessed at one and five minutes post-birth, and maternal and neonatal complica tions were evaluated. Results: Neonates delivered under spinal anesthesia showed significantly higher Apgar scores at both one minute (8.2 ± 1.0 vs. 7.5 ± 1.3, p < 0.01) and five minutes (9.3 ± 0.7 vs. 8.8 ± 1.1, p < 0.01) compared to those delivered under general anesthesia. Nausea and vomiting were more frequently observed in the general anesthesia group (32% vs. 12%), while hypotension was more common in the spinal anesthesia group (20% vs. 8%). Neonatal complications such as the need for resuscitation (20% vs. 8%) and NICU admission (16% vs. 4%) were also higher with general anesthesia. Multivariate analysis indicated spinal anes thesia as a significant predictor of higher Apgar scores (AOR = 1.65, 95% CI: 1.25–2.16, p < 0.01), along with gestational age (AOR = 1.05, p = 0.03). Maternal age and parity had no significant effect. Conclusion: The findings highlight the clinical advantage of spinal anesthesia in cesarean sections, as it is associated with better neonatal Apgar scores and fewer complications. Spinal anesthesia should be considered the preferred technique when appropriate to enhance both maternal and neonatal outcomes.