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This review of second\u2010stage labor care practices discusses risk factors for perineal trauma and prolonged second stage and scrutinizes a variety of care practices including positions, styles of pushing, use of epidural analgesia, and perineal support techniques. Current evidence for management of the second stage of labor supports the practices of delayed pushing, spontaneous (nondirected) pushing, and maternal choice of positions. Perineal compresses, perineal massage with a lubricant, and controlling the rate of fetal extension during crowning may prevent severe perineal trauma at birth. Supine positioning is not recommended. Upright positions and directed pushing can shorten the time from onset of second stage to birth and may be indicated in certain situations, although directed pushing has some associated risks. If the fetus is in the occiput posterior position, immediate pushing is not recommended, and manual rotation can be effective in correcting the malposition. Women should be informed of the potential effects of epidural analgesia on labor progress. Consultation and intervention to expedite birth may be indicated when birth is not imminent after 2 hours of active pushing, or 4 hours complete dilatation, for nulliparous women; or one hour of pushing, or 2 hours complete dilatation, for multiparous women. Each woman should be individually assessed and apprised of the potential risks to her and her fetus of a prolonged second stage of labor, and some women may choose to continue pushing beyond these time limits.<\/jats:p>","DOI":"10.1111\/jmwh.12199","type":"journal-article","created":{"date-parts":[[2014,5,21]],"date-time":"2014-05-21T16:56:33Z","timestamp":1400691393000},"page":"264-276","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":70,"title":["A Review of Evidence\u2010Based Practices for Management of the Second Stage of Labor"],"prefix":"10.1111","volume":"59","author":[{"given":"Mary Lou","family":"Kopas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,5,21]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wombi.2010.09.002"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wombi.2011.05.001"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1957.tb08483.x"},{"key":"e_1_2_10_5_1","volume-title":"Listening to Mothers SM III: Pregnancy and Birth","author":"Declercq ER","year":"2013"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.77.5.636"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2012.04.021"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-536X.2002.00151.x"},{"key":"e_1_2_10_9_1","first-page":"CD002006","article-title":"Position in the second stage of labour for women without epidural anaesthesia","volume":"5","author":"Gupta JK","year":"2012","journal-title":"Cochrane Database Syst Rev."},{"key":"e_1_2_10_10_1","first-page":"CD008070","article-title":"Position in the second stage of labour for women with epidural anaesthesia","volume":"1","author":"Kemp E","year":"2013","journal-title":"Cochrane Database Syst Rev."},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/JPN.0b013e318196526b"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-2011.2011.00074.x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2000.105197"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(01)01642-8"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006199-200505000-00002"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6909.2010.01195.x"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/NMC.0b013e3181cae7ad"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2004.00282.x"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6909.2007.00205.x"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182639fae"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/JNR.0b013e3181999e78"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)32257-5"},{"key":"e_1_2_10_23_1","volume-title":"Nursing Care and Management of the Second Stage of Labor","author":"Association of Women's Health, Obstetric and Neonatal Nurses","year":"2008"},{"key":"e_1_2_10_24_1","volume-title":"The Second Stage of Labour. 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