Pushing takes longer than the hour you were promised
For a first baby the 95th centile of pushing is 3.6 hours with an epidural and 2.8 hours without; for a second baby it is 2.0 and 1.3 hours.
The second stage is from full dilation to the birth of the baby. Here is what it actually takes, from the same 62,415-woman American dataset, split by how many babies you have had and by whether you have an epidural.
| Which baby | Epidural | Median | 95th centile |
|---|---|---|---|
| First | Yes | 1.1 h (66 min) | 3.6 h (216 min) |
| First | No | 0.6 h (36 min) | 2.8 h (168 min) |
| Second | Yes | 0.4 h (24 min) | 2.0 h (120 min) |
| Second | No | 0.2 h (12 min) | 1.3 h (78 min) |
| Third or later | Yes | 0.3 h (18 min) | 1.6 h (96 min) |
| Third or later | No | 0.1 h (6 min) | 1.1 h (66 min) |
The epidural does lengthen pushing, and here is by how much. For a first baby, the 95th centile is 0.8 hours longer with an epidural than without: 3.6 hours against 2.8. ACOG rounds that in its own guideline: In the Consortium on Safe Labor study, the 95th percentile threshold was approximately 1 hour longer in patients who received epidural analgesia than in those who did not receive epidural analgesia.
If you see the figure quoted as an hour, that is ACOG rounding 0.8 up.
What counts as too long. ACOG's current guideline says: ACOG recommends that prolonged second stage of labor be defined as more than 3 hours of pushing in nulliparous individuals and 2 hours of pushing in multiparous individuals. An individualized approach should be used to diagnose second-stage arrest; incorporating information regarding progress, clinical factors that may affect the likelihood of vaginal delivery, discussion of risks and benefits of available interventions, and individual patient preference is recommended when time in the second stage is extended beyond these parameters.
Notice what that means. The clinical line for a first baby is 3 hours, and the 95th centile of ordinary pushing that ended in a normal vaginal birth is 3.6 hours. The line does not sit at the far edge of normal; it sits inside it, on purpose, as a trigger for a conversation. ACOG's own wording asks for that conversation to include what you want.
WHO puts it the same way for patients: Women should be informed that the duration of the second stage varies from one woman to another. In first labours, birth is usually completed within 3 hours whereas in subsequent labours, birth is usually completed within 2 hours.
Every woman in this table had a vaginal birth and a healthy baby. A long second stage is not, by itself, a bad outcome. It is one of the things that can happen inside a normal birth.
"Am I at the point where you would normally start a conversation about help, or past it?"
"If nothing is worrying you about me or the baby, can we keep going?"