Individualization of pushing duration is essential: spontaneous delivery probabilities vary drastically based on parity, epidural use, and fetal head position.
Epidural analgesia is a potent risk factor for persistent occiput posterior (OP) position at delivery (aOR 4.0), significantly reducing the likelihood of spontaneous vaginal birth.
Active pushing for more than 30 minutes is associated with elevated risks of obstetric anal sphincter injuries (OASI), postpartum hemorrhage (PPH), and adverse neonatal outcomes.
Delayed pushing policies (passive second stage) can drastically shorten the duration of active expulsive efforts, often to under 15 minutes, without compromising safety.
