Background Epidural analgesia is one of the most effective forms of pain relief during various stages of labor. Despite its many advantages, the technique is not routinely practiced in most centers in developing countries. Awareness and attitudes toward it, as well as the reasons for its limited utilization, have not been explored in our setting. Therefore, the aim of this study was to assess the awareness and attitudes of pregnant women toward labor epidurals and to assess the factors influencing their decision to receive labor epidural analgesia (LEA) during labor and delivery. Methods A cross-sectional study was conducted from June to August 2024 at Hemen Medical Center. A structured questionnaire was used to collect the data. The collected data were analysed via SPSS version 26. Descriptive statistics were used to summarize the descriptive results, and logistic regression was employed to identify factors associated with the decision to receive labor epidural analgesia during delivery. A p value of < 0.05 was used to determine statistical significance. Results Two hundred thirty pregnant women, with a mean age of 30 ± 4.3 years, were included in the analysis. Approximately 78% of the participants had heard of labor epidural analgesia (LEA), although only 6.5% reported healthcare providers as their primary source of information. Approximately 47% believed that LEA was effective for pain relief during labor. However, only 14.3% expressed a willingness to consider using LEA during delivery. Education level, family income, perceived risk to the Fetus, and perceived effectiveness in relieving pain were identified as factors influencing the decision to consider LEA during delivery. Conclusion Despite relatively high basic awareness of LEA, many participants remain hesitant to utilize it during labor and delivery. Comprehensive health education and counselling during antenatal care are essential to address misconceptions and promote informed decision-making regarding LEA.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

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Ethiopian Association of Anaesthetists Institutional Research Ethics Review Committee (EAA IRERC) is an accredited etical review committee located in Ethiopia and provided the clearance for this study with Protocol Number: EAA/16/30895/005.

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