From the Guidelines
Active pushing should not exceed 2-3 hours for first-time mothers or 1-2 hours for those who have given birth previously, with a recommended passive descent phase of 1-2 hours or until the woman feels the urge to push. The second stage of labor, which involves the descent of the fetus through the birth canal and delivery, may take between 30 minutes and 2 hours 1. During this stage, it is essential to balance the need for timely delivery with the importance of avoiding excessive maternal exhaustion and promoting effective pushing. A passive descent phase, where the woman delays pushing until she feels the urge to do so, can help reduce maternal exhaustion and decrease the duration of active pushing efforts. The American College of Obstetricians and Gynecologists (ACOG) recommends that women with epidural anesthesia be allowed to rest for 1-2 hours or until they feel the urge to push, unless there are concerns about fetal well-being or lack of descent despite adequate contractions. Key considerations during the second stage of labor include:
- Position changes to enhance pushing effectiveness
- Adequate hydration to support maternal well-being
- Supportive coaching to promote effective pushing and reduce anxiety
- Close monitoring of fetal well-being and maternal status to inform decision-making about the timing and duration of active pushing.
From the Research
Active Pushing vs Passive 2nd Stage
- The duration of the second stage of labor can vary significantly between active pushing and passive second stage, with some studies suggesting that passive second stage can last longer than active pushing 2, 3.
- A study published in 2017 found that the second stage of labor was significantly longer with spontaneous pushing compared to Valsalva pushing, with a mean duration of 64.4 minutes for spontaneous pushing and 46.4 minutes for Valsalva pushing 2.
- Another study published in 2020 found that delayed pushing in the second stage of labor resulted in a significantly shorter length of active pushing, with a mean difference of -27.54 minutes, but a longer overall duration of the second stage of labor, with a mean difference of 46.17 minutes 3.
- The American College of Obstetricians and Gynecologists (ACOG) recommends that women be allowed to push for at least 2 hours in the second stage of labor if they have epidural anesthesia, and at least 3 hours if they do not have epidural anesthesia, but the optimal duration of active pushing is not well established 4, 3.
Duration of Active Pushing
- The duration of active pushing can vary significantly between studies, with some studies suggesting that active pushing can last anywhere from 30 minutes to several hours 2, 3, 5.
- A study published in 2020 found that delayed pushing in the second stage of labor resulted in a significantly shorter length of active pushing, with a mean difference of -27.54 minutes 3.
- Another study published in 2025 found that discontinuation of oxytocin in the active phase of labor increased the duration of active labor by an average of 30 minutes and the second stage of labor by an average of 6 minutes 5.
Comparison of Active Pushing and Passive 2nd Stage
- A study published in 2002 suggested that the evidence does not support arbitrary time limits for the second stage of labor, and that the duration of active pushing is associated with fetal acidosis and denervation injury to maternal perineal musculature 4.
- Another study published in 2020 found that delayed pushing in the second stage of labor did not affect the mode of delivery, but reduced the time of active pushing at the expense of a longer second stage, and was associated with a higher incidence of chorioamnionitis and low umbilical cord pH 3.