**5. Conclusion**

Optimizing the management of the second stage of labor involves considering factors such as pelvic shape and size, fetal position and presentation, Montevideo units, Valsalva forces, timing of pushing, maternal position, and considering operative vaginal deliveries when appropriate. Optimal, evidence-based practice recommendations include:


It is important to appreciate that an unplanned and emergent cesarean section during second stage of labor is associated with a significantly increased maternal and perinatal morbidity and mortality [38]. Therefore, every attempt should be made to achieve a safe vaginal birth. To facilitate this goal, it may be necessary to redefine the optimal length of the second stage of labor, considering alternative clinical

measurements such as the cumulative length of time a patient spends pushing, the number of pushes, and/or the cumulative force generated.

Lastly, it is important to note that obesity presents numerous challenges throughout pregnancy, and these challenges may become more pronounced in the second stage of labor. Ultimately, the most effective strategy for minimizing complications during pregnancy and delivery is the prevention of obesity itself and achieving adequate weight loss prior to conception.
