Does extending time limits in the second stage of labour compromise maternal and neonatal outcomes?

The second stage of labour is defined as full cervical dilation until delivery of the baby. In fact, it is so much more. The woman embodies both physical strength and emotional vulnerability as with each push she journeys closer to the life changing rite of passage that is motherhood. Labour has long been conceptualised into stages with measurements and time limits. In 1954, EA Friedman devised the partograph, enabling women's labours to be managed with time constraints and boundaries. Despite a Cochrane review (Lavender et al, 2013) concluding that the use of the partograph was not recommended, this approach continues to underpin midwifery practice, potentially resulting in superfluous physical and emotional suffering for women undergoing interventions to shorten their labour.

This literature review sought to investigate whether low risk mothers and babies suffered adverse effects when the second stage of labour was extended beyond ‘normal’ time limits. These limits are defined by the National Institute for Health and Care Excellence (NICE) (2014) as 3 hours in primiparous women and 2 hours in multiparous women; however, the Royal College of Obstetricians and Gynaecologists (RCOG) (2011) and Trust guidelines provide conflicting advice, meaning that it can be difficult to gain consistency and promote normality.