Management of the second stage of labor

The second stage of labor is regarded as the climax of the birth by the delivering woman, her partner, and the care provider. International health policy and programming have placed emphasis on the first stage of labor, including appropriate use of the partogram and identification of hypertension or sepsis, and have also focused on the third stage of labor with active management (AMTSL). More recently, a concerted effort to reduce perinatal losses has been made through dissemination of skills in neonatal resuscitation. However, the provision of skilled care and avoidance of complications during the second stage of labor have been relatively neglected. These guidelines are intended to strengthen policy and frameworks for care provision to enable providers to attend to women in the second stage of labor in line with current evidence-based recommendations for practice to optimize outcomes for mother and baby. The document is not intended as a formal systematic review of the literature, but aims to identify important clinical, programmatic, and policy issues that require attention. The 3 stages of labor are conventionally defined as: