(Abstracted from JAMA 2018;320(14):1444–1454)
Despite the frequency of childbirth, many aspects of labor management lack an evidence-based approach. The second stage of labor, defined as the interval from complete cervical dilation through delivery of the fetus, is the most physiologically demanding period of labor for both the mother and the fetus.
Department of Obstetrics and Gynecology, School of Medicine, Washington University in St Louis, St Louis, MO (A.G.C., C.W., D.L.W., G.A.M., M.G.T.); Department of Obstetrics and Gynecology, Perelman School of Medicine, Maternal and Child Health Research Center, University of Pennsylvania, Philadelphia, PA (S.K.S.); Department of Obstetrics and Gynecology (A.T.N.T., H.E.R.), and Center for Women's Reproductive Health (A.T.N.T., H.E.R.), University of Alabama, Birmingham, AL; Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR (A.B.C., W.T.G.); and Division of Public Health Sciences, School of Medicine (J.L.), and Department of Pediatrics, School of Medicine (A.M.M.), Washington University in St Louis, St Louis, MO