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Aim: The study aimed to describe the various ways in which Italian midwives reconcile their profession's philosophical views about labor with the use of epidural analgesia in clinical practice. Design: Interpretive description. Methods: A purposeful sample of 41 midwives and 12 midwifery students participated in the study. Information about their perceptions and experiences of the use of epidural analgesia and how this practice aligns with their professional values were explored through in-depth interviews (n = 10 focus groups; n = 1 one-to-one interview). The constant comparative method was used to analyze the data. Results: With respect to aligning midwifery care with the administration of epidural analgesia, two midwifery positions were identified: the midwife that acted "in harmony" and the "disoriented midwife", defined by three dimensions: 1) the midwife's conception of her professional role; 2) the woman's attitude towards labor and; 3) the midwife's relationship and comfort with other professionals in the labor room. Conclusion: The results of this research highlight how difficult it can be for a midwife to reconcile a specific philosophical view of labor with the use of epidural analgesia. These findings can provide useful insights to help midwives in the challenging task of combining epidural analgesia with their philosophical view of labor to offer a better birth experience to women.