This study aims to understand whether informing laboring patients about how long they have been pushing during the second stage of labor affects the length of that stage and the overall childbirth experience.
The second stage of labor is the period from when the cervix is fully dilated until the baby is delivered. When this stage lasts longer than expected, it can increase the chance of complications such as assisted delivery with vacuum or forceps, cesarean delivery, heavy bleeding after delivery, and certain neonatal complications. Although healthcare providers routinely track the duration of the second stage, patients are not always told how long they have been pushing. Some providers believe that sharing this information may help motivate patients and improve their sense of control, while others worry that it could increase stress or pressure.
In this study, participants will be randomly assigned to one of two groups. In the intervention group, patients will receive regular updates about how long they have been pushing during the second stage of labor, and a visible timer will be used. In the comparison group, patients will receive standard care, which does not include structured time updates.
All participants will receive the same medical care otherwise. The study will measure the length of the second stage of labor as well as maternal and neonatal outcomes such as the type of delivery, postpartum complications, newborn health indicators, and admission to the neonatal intensive care unit. Participants will also be asked to complete a short questionnaire after delivery about their childbirth experience and sense of control during labor.
The risks of this study are minimal because the intervention involves only providing information about time during labor. There are no changes to medical treatment or standard care. The information gained from this research may help clinicians improve communication with patients during labor and may identify simple ways to enhance patient experience and potentially improve labor outcomes.
Participation in the study is voluntary, and patients may decline or withdraw at any time without affecting the care they receive.
Singleton, cephalic presentation
Gestational age ≥ 37+0 weeks at delivery.
Reached the second stage of labor (complete cervical dilation with intention to proceed with vaginal delivery).
Ability to understand study information and provide informed consent.
Planned cesarean delivery.
Intrauterine fetal demise.
Critical maternal illness requiring intensive hemodynamic or respiratory support.
Cognitive impairment or language barrier precluding consent and comprehension of instructions.
Parallel
Time aware
BehavioralParticipants randomized to the intervention arm will receive structured awareness of the duration of the second stage of labor. At complete cervical dilation, a nurse or provider will initiate an electronic timer and inform the participant that elapsed pushing time will be monitored and communicated throughout the second stage. The timer will be visible to the participant. Standardized verbal updates on elapsed time will be provided every 30 minutes, with additional reminders at clinically relevant thresholds based on parity and neuraxial analgesia status. Feedback will be supportive, non-coercive, and focused on encouragement and shared decision-making. The intervention is intended to increase maternal awareness of labor progress without changing clinical management. All other aspects of care, including labor positioning, coaching, analgesia, fetal monitoring, and decisions regarding operative vaginal delivery or cesarean delivery, will follow standard institutional protocols.
Mean difference of the duration of the second stage of labor
The duration of the second stage will be recorded from the time of full cervical dilation to the expulsion of the neonate.
Duration of the second stage of labor
How long it took from full cervical dilatation to delivery of the fetus
Maternal satisfaction and perceived control
The Labor agentry scale scored from 10-70. Higher scores indicate greater sense of autonomy, empowerment, and active involvement during labor. Lower scores indicate helplessness, a loss of control, or feeling overwhelmed by the birthing process.
Maternal self-report exhaustion
A likert scale to assess maternal exhaustion
Degree of perineal laceration.
First-degree tear: superficial skin or vaginal mucosal laceration Second-degree tear: laceration extends through underlying perineal muscles but no sphincter involvement. Third-degree tear: laceration extends to external and or internal anal spincters but not the rectal mucosa. Fourth-degree tear: Laceration involves the rectal mucosa
5-minute APGAR score
The Apgar score compreises of 5 components, weighed evenly and assigned 0,1,or 2. The components are summed at 5 minutes after delivery of the neonate. Activity(0= absent; 1= some tone and flexed limbs; 2= active), Pulse( 0= no pulse; 1= less than 10bpm; 2= greater than 100bpm), Grimace( 0= floppy; 1= minimal response; 2=prompt response), Appearance(0= blue or pale; 1= pink body, blue limbs; 2= pink body and limbs), Respiration( 0=absent breathing; 1= slow and irregular breathing; 2= vigorous cry) A score of \<7/10 is considered non-reassuring, while 7 or more is considered assuring neonatal status.
Postpartum endometritis
Diagnosed by the presence of at least two (2) of the following: 1\. Fever (temperature greater than or equal 38 degrees celcius or 100.4 degree Fahrenheit; 2. Pain or uterine tenderness with no other recognized cause and 3. purulent drainge from the uterus.
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Valmiki Vijay Seeraj
Lead sponsor
Bronxcare Hospital System
Sponsor institution
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