When will we change practice and stop directing pushing in labour?

There have been many papers written about the issue of pushing in the second stage of labour, and yet anecdotally some midwives are still restricted by labour ward policies of timed second stages, active pushing once fully dilated and subsequent interventions when time runs out. Research is fraught with frustration on occasion; some studies stop early because of preliminary findings indicating obvious benefits, while others, although offering beneficial findings, are often ignored and traditional practices continue. This article considers the research supporting spontaneous pushing in labour; it asks why change is so difficult and then considers what could be done to encourage a change in practice. The article finds that women should be allowed to push spontaneously. A change in clinical practice is recommended. It considers whether further research is necessary, or whether a change in the definitions used for the stages of labour would allow midwives to let women dictate when to push.