Introduction: Hypertensive problems are prevalent during pregnancy and increase the risk of other issues and long-term effects for both the mother and her unborn child. The current study aimed to test the hypothesis that pregnant women experiencing a hypertensive crisis are better treated with oral nifedipine than intravenous (IV) labetalol in terms of reaching their goal blood pressure (BP). Materials and methods: A randomized clinical trial was done with 45 participants in each group over 1 year and 2 months, group A (IV labetalol) and group B (oral nifedipine), from March 2023 to April 2024 at KLE Academy of Higher Education and Research's Dr Prabhakar Kore Hospital and Medical Research Center, Belagavi. The study included pregnant women of 20 weeks’ gestation or more with acute severe hypertension (gestational hypertension, pre-eclampsia, and eclampsia) with systolic BP (SBP) ≥160 mm Hg and diastolic BP (DBP) ≥110 mm Hg, presenting to the labor room. Others were excluded. Results: The mean age of patients was similar in both groups (p = 0.753). Group A had primigravida patients 57.78% compared with group B with 46.67% (p-value = 0.018). The mean SBP for all patients was significantly higher in group A (168.4 ± 8.83 mm Hg) compared with group B (163.42 ± 5.07 mm Hg), with a p-value of 0.001. The mean DBP was 103.91 ± 7.05 mm Hg for group A and 100.36 ± 6.4 mm Hg for group B (p = 0.015). In group A, 22.22% of patients and a significant 92.89% of patients in group B achieved the target at 20 minutes. Regarding the number of doses, 57.78% of patients in group A required only one dose, compared with 93.33% in group B. Patients in group A required higher doses and took more time to manage BP. Conclusion: Oral nifedipine is more effective in achieving target BP faster and with fewer doses than IV labetalol.