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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
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Related Experiment Video

Updated: Mar 30, 2026

Author Spotlight: Advancing Labor Management Through Electromyometrial Imaging for Understanding Uterine Contractions
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Second-stage labor: how long is too long?

Kenneth J Leveno1, David B Nelson1, Donald D McIntire1

  • 1Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.

American Journal of Obstetrics and Gynecology
|November 8, 2015
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The latest recommendations suggest longer second stage of labor is safe, but evidence indicates potential risks to infant safety. Robust data is needed before changing established obstetric practices for labor management.

Keywords:
cesarean deliveryepidural analgesiainfant outcomeprolongedsecond stage of laborsecond-stage labor

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Neonatal Safety

Background:

  • Rising cesarean delivery rates in the US prompted a re-evaluation of labor management guidelines.
  • Recommendations from a joint workshop proposed extending the second stage of labor duration for women with epidural analgesia.

Observation:

  • The Obstetric Care Consensus document updated guidelines, allowing longer second stage of labor durations, exceeding historical obstetric precepts.
  • This clinical opinion reviews historical and recent evidence concerning infant safety in relation to the duration of the second stage of labor.

Findings:

  • The current evidence fails to substantiate the safety of prolonged second stage of labor for unborn infants.
  • Evidence suggests that extended second stage of labor may pose risks to infant well-being, contrary to recent consensus recommendations.

Implications:

  • The findings challenge the robustness of the evidence supporting the updated guidelines on second stage of labor duration.
  • Further rigorous research is crucial to ensure infant safety before adopting new clinical practices in labor management.