I am pretty against vaginal exams in hospitals, but I always talk to my clients about vaginal exams when it comes to epidurals. Sometimes, it is the very thought of relief (especially with a LONG drawn out labor) that gets the mother to do the dilating she needed to do...so I suggest that when she makes the decision to get an epidural, the mother get a vaginal exam. SOmetimes, by the time that hour or so is past and they are ready to actually have the epidural placed, if she were to get another vaginal, the information found could actually be quite useful...like she is a nine or a ten, and by the time the drugs took effect, the baby would likely be born.
It is important for women to know that about 90% of the time, when a woman is asking for pain relief outside of the physical and emotional support she is receiving from her family/friends, she is in transition...and transition is the shortest part of labor--on average lasting 45 mins to an hour...just about the same amount of time it takes to get stuff together for the epidural.
I agree with salmonbaydoula, I have seen different status quo, depending on the doc, the nursing staff, and the hospital. I HAVE seen docs actually (albiet as if they were debaters in the contest of a lifetime, at triple speed...) go through the actual dangers of epidural. However, by that time, the woman is just not in a place to actually process what is being said. Luckily, in the case of my clients, we have gone over and over the risks and benefits of interventions that are likely to be offered, so they ARE able to make truely informed consent, regardless, because they have thought about it ahead of time. Unfortunately, not every woman has a doula!
I, too, have seen docs give the worst possible side effect as being a spinal headache (which I have experienced and is truely awful, terrible, horrible, debilitating and excruciating...but NOT the worst thing that can happen from an epidural!), and that rather breezily, with "and we can FIX that, too!" tacked on to the end. It all depends, though on who is there and what the protocol for that place entails.