Effect of Maternal Awareness of the Duration fo the Second Stage of Labor on the Length of the Second Stage

June 15, 2026 updated by: Valmiki Vijay Seeraj

Effect of Maternal Awareness of the Duration fo the Second Stage of Labor on the Length of the Second Stage: A Randomized Controlled Trial

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.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Background and Rationale The second stage of labor, defined as the interval from complete cervical dilation to delivery of the fetus, is a critical phase of childbirth with important implications for maternal and neonatal outcomes. Prolonged second stage of labor has been associated with increased risks of operative vaginal delivery, cesarean delivery, postpartum hemorrhage, severe perineal lacerations, chorioamnionitis, and neonatal morbidity, including low Apgar scores and neonatal intensive care unit (NICU) admission. As a result, contemporary obstetric guidelines provide time-based thresholds to define prolonged second stage, often stratified by parity and use of neuraxial analgesia.

Despite the centrality of time thresholds in clinical decision-making, clinicians typically monitor second-stage and are recommended to continuously communicate with the parturient[a]. While some providers may offer general reassurance ("you're making progress"), others may avoid discussing time altogether, out of concern that emphasizing elapsed duration could increase anxiety, fatigue, or a sense of pressure. Consequently, the extent to which parturients are aware of the duration of the second stage varies widely and is largely unstructured.

Patient engagement and shared decision-making have increasingly been recognized as important components of high-quality obstetric care. In non-obstetric clinical settings, real-time feedback and awareness of performance metrics-such as elapsed time, distance, or workload-have been shown to influence behavior, motivation, and outcomes. In labor, behavioral factors such as maternal effort, positioning, coping strategies, perceived control, and coached pushing may plausibly affect the effectiveness of pushing and overall labor progress. However, the specific role of maternal awareness of elapsed time during the second stage of labor has not been systematically studied.

Existing literature on second-stage management has largely focused on physiologic versus directed pushing, delayed versus immediate pushing, maternal positioning, and clinician-led coaching strategies. While these studies provide important insights, they do not address whether informing the laboring person about the duration of the second stage-without altering clinical management-affects the second stage's length.

Importantly, maternal experience and satisfaction are increasingly recognized as meaningful outcomes in obstetric research. A sense of control, understanding of the labor process, and effective communication have been associated with greater satisfaction with childbirth and a reduced risk of negative birth experiences. Whether structured communication about second-stage duration enhances or detracts from these aspects of the birth experience remains unknown.

Given the lack of high-quality evidence on this topic, a randomized controlled trial is needed to evaluate the impact of structured maternal awareness of second-stage duration on second-stage labor duration and related maternal and neonatal outcomes. Such evidence would directly inform clinical communication practices during labor and could offer a low-cost, easily scalable intervention to optimize labor outcomes while supporting patient-centered care.

2. Objectives and Hypotheses Primary Objective To determine whether structured maternal awareness of the duration of the second stage of labor reduces the length of the second stage of labor compared with usual care.

Secondary Objectives

  1. To assess the impact of the intervention on:

    • Mode of delivery (spontaneous vaginal vs operative vaginal vs cesarean delivery in the second stage).
    • Maternal outcomes: perineal laceration degree, postpartum hemorrhage, maternal exhaustion, need for operative assistance.
    • Neonatal outcomes: 5-minute Apgar score, umbilical artery pH (if available), NICU admission.
    • Maternal satisfaction with the birth experience and perceived sense of control.

  2. To evaluate whether the effect of the intervention differs by parity and use of neuraxial analgesia.

    Hypotheses

    • Primary hypothesis: Women who receive structured feedback about the elapsed duration of the second stage will have a shorter median second stage of labor than women receiving usual care.

    • Secondary hypotheses:

      • The intervention will not worsen maternal or neonatal morbidity.
      • Maternal satisfaction and perceived control will be higher in the intervention group.
  3. Study Design A single-center, parallel-group, randomized controlled trial with a 1:1 allocation ratio.
  4. Setting The trial will be conducted on the Labor and Delivery unit of Bronxcare, a community hospital with approximately 1500 births per year.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
240

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Contact Backup

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • 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.

Exclusion Criteria:

  • 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.
  • Abnormal fetal heart tracing requiring operative vaginal delivery
  • Shoulder dystocia requiring maneuvers other than McRoberts and suprapubic pressure

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Time awareness
Participants 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.
Behavioral: Time aware
Participants 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.
No Intervention: Usual care
Participants randomized to the usual care arm will receive standard obstetric management during the second stage of labor. Clinicians will manage the second stage according to routine clinical practice, but no structured or protocolized communication regarding elapsed pushing time will be provided. Participants will not have access to the study timer, and healthcare providers will not be instructed to provide scheduled updates on the duration of the second stage. Any communication regarding labor progress will occur at the discretion of the clinical team and in accordance with standard practice. All other aspects of care, including labor support, maternal positioning, pushing techniques, pain management, fetal monitoring, and decisions regarding operative vaginal delivery or cesarean delivery, will be managed according to existing institutional protocols and provider judgment.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Mean difference of the duration of the second stage of labor
Time Frame: From complete cervical dilation(10cm-which is the start of the second stage) to delivery of the neonate(either spontaneously or operative vaginal delivery), or cessation of pushing for cesarean delivery, maximum of 4 hours from complete cervical dilation
The duration of the second stage will be recorded from the time of full cervical dilation to the expulsion of the neonate.
From complete cervical dilation(10cm-which is the start of the second stage) to delivery of the neonate(either spontaneously or operative vaginal delivery), or cessation of pushing for cesarean delivery, maximum of 4 hours from complete cervical dilation
Duration of the second stage of labor
Time Frame: full cervical dilatation to expulsion of the fetus
How long it took from full cervical dilatation to delivery of the fetus
full cervical dilatation to expulsion of the fetus

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Maternal satisfaction and perceived control
Time Frame: Within 48 hours postpartum
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.
Within 48 hours postpartum
Maternal self-report exhaustion
Time Frame: within 24 hours postpartum
A likert scale to assess maternal exhaustion
within 24 hours postpartum
Degree of perineal laceration.
Time Frame: Within 10-minutes from the delivery of the placenta

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
Within 10-minutes from the delivery of the placenta
5-minute APGAR score
Time Frame: 5 minutes after delivery of neonate.

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.
5 minutes after delivery of neonate.
Umbilical artery pH
Time Frame: Sample collection: 0 to 5 minutes from resection of the umbilical cord. Analyzed within 60 minutes of collection.
The pH of the umbilical artery aspirated from a 10-20cm doubly clamped and resected segment of the umbilical cord. The cord blood will be aspirated with a 2mL Heparin-flushed syringe and immediately transported to the laboratory on ice.
Sample collection: 0 to 5 minutes from resection of the umbilical cord. Analyzed within 60 minutes of collection.
Neonatal Intensive Care Unit(NICU) admission
Time Frame: From birth to 72 hour after delivery.
Admission of neonate to NICU due to factors associated with the labor and delivery of the neonate.
From birth to 72 hour after delivery.
Duration of NICU admission
Time Frame: From birth to 7 days
length of stay of admitted neonates to the NICU.
From birth to 7 days
Quantifiable blood loss
Time Frame: From 0 to 24 hours after delivery of neonate
The volume of blood loss after delivery of neonate
From 0 to 24 hours after delivery of neonate
Mode of delivery
Time Frame: From full cervical dilation to delivery of neonate( within 4 hours)

The final mode of delivery:

  1. Spontaneous vaginal delivery
  2. Operative vaginal delivery ( forceps or vacuum-assisted vaginal delivery)
  3. Cesarean delivery
From full cervical dilation to delivery of neonate( within 4 hours)

Other Outcome Measures

Other Outcome Measures

For clinical trials, a planned measurement described in the protocol that is used to determine the effect of an intervention/treatment on participants. For observational studies, a measurement or observation that is used to describe patterns of diseases or traits, or associations with exposures, risk factors, or treatment. Types of outcome measures include primary outcome measure and secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Postpartum endometritis
Time Frame: Time of delivery to discharge of mother( within 96 hours after delivery)

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.
Time of delivery to discharge of mother( within 96 hours after delivery)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Valmiki Vijay Seeraj

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Valmiki Vijay Seeraj, MD, Bronxcare Healthcare System
  • Study Director: Emmanuel Afful, MD, MPH, Bronxcare Healthcare System

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

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Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
July 1, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
July 1, 2028

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
July 1, 2029

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
June 1, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 15, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
June 17, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
June 17, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 15, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
June 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 04092601

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

IPD Plan Description

We are not decided on sharing patient's protected information to other researchers who were not declared to the IRB of Bronxcare Healthcare System.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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