This article focuses on the primary clinical issues during the second stage of labor: diagnosis, duration, maternal bearing-down efforts, and fetal descent, and ways to help women with their expulsive efforts during this time. A pattern of progression for the second stage/expulsive phase of labor is presented, with an emphasis on the importance of delaying direction to or encouragement of the woman to push until the obstetric conditions are optimal for descent and the women has entered the active phase of the second stage. Ongoing assessment of fetal status and descent, the quality of uterine contractions, and maternal condition are emphasized, rather than arbitrary time limits for the second stage. The use of various care practices, including maternal position and alternative bearing-down techniques, which optimize maternal and fetal outcomes, is described. Finally, women's concerns about this major life experience are considered in the context of the care that they receive during the second stage of labor.