The authors highlight the notion of there being no optimal duration for the second stage of labor and how duration alone should not guide clinical management.

We agree with the authors about the inconsistency of the evidence in supporting a particular optimal time to abide by for both the second-stage duration and the pushing duration. Our manuscript was presented to underline the timing at which neonatal and maternal morbidity outcomes begin to develop and to characterize the risks in relation to a continuous timeline. Our manuscript acknowledges the effects of individualized factors, including but not limited to parity and epidural analgesia.

Politi and Dall’Asta delineate the inconsistent evidence with respect to the clinical role of the latent phase of the second stage. Our analysis, hence, reasonably focused on the total second-stage duration and the active pushing duration. Our findings show a positive correlation between the length of the second stage and maternal and neonatal morbidity outcomes. Studies have shown the increased risks of forceps and cesarean delivery with prolongation of the second stage of labor. Data examining the effect of the pushing duration are limited, and our outcomes are based on pooled estimates that rely on a small, clinically heterogeneous subset of studies, limiting generalizability.

In conclusion, we recognize the importance of using an individualized approach to guide management. Our manuscript serves to aid clinical decisions based on parity and epidural status. We agree with the authors that duration alone should not dictate intervention; rather, second-stage management should balance timely action against unnecessary operative delivery. We appreciate Politi and Dall’Asta’s contribution and share the notion that continued research is needed to refine patient-centered, individualized strategies aimed at optimizing maternal and neonatal outcomes.

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