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The second stage of labor 

The second stage of labor
The second stage of labor

Murray Enkin

, Marc J. N. C. Keirse

, James Neilson

, Caroline Crowther

, Lelia Duley

, Ellen Hodnett

, and Justus Hofmeyr

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date: 26 November 2020

There are no data to support a policy of directed pushing during the second stage of labor, and some evidence to suggest that it may be harmful. The practice should be abandoned. Similarly, there is no evidence to justify forcing women to lie flat during the second stage of labor. With some reservations, the data tend to support the use of upright positions. There is a tendency for recumbency to lengthen the second stage of labor, to reduce the incidence of spontaneous births, to increase the incidence of abnormal fetal heart-rate patterns, and to reduce umbilical cord blood pH. On the other hand, at least some of the birthing chairs that have been introduced during recent years appear to predispose to perineal edema and venous engorgement which, in conjunction with perineal trauma, can result in increased loss of blood. Use of a birthing chair is not, however, the only way of adopting an upright position during labor. The mother should be encouraged to use the position that she prefers. There is no evidence to suggest that, when the second stage of labor is progressing and the condition of both mother and fetus is satisfactory, the imposition of any upper arbitrary limit on its duration is justified. Such limits should be discarded. There is some evidence to support the practices of guarding the perineum, but none to support claims that liberal use of episiotomy reduces the risk of severe perineal trauma, improves perineal healing, prevents fetal trauma, or reduces the risk of urinary stress incontinence after delivery. Episiotomy should be used only to relieve fetal or maternal distress, or to achieve adequate progress when it is the perineum that is responsible for lack of progress.

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