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Second-Stage C-Sections: Understanding Risks and Ensuring Safer Deliveries

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Soraya Malik in Health & Wellness October 2026 • 4 min read.

"A deep dive into the factors driving second-stage cesarean sections, their impact on maternal and infant health, and strategies for safer childbirth."


Cesarean sections (C-sections) are a common surgical procedure, but their increasing rates raise concerns about potential risks for both mothers and babies. Of particular concern is the rise in second-stage C-sections, performed when labor is already well underway. Understanding the factors driving this trend and the associated risks is crucial for ensuring safer deliveries.

A recent study conducted at a tertiary center in Nepal sheds light on the complexities of second-stage C-sections. The research examines the indications for these procedures, the complications that can arise, and the impact on maternal and infant health. By analyzing data from over 40,000 deliveries, the study provides valuable insights into optimizing childbirth practices.

This article breaks down the key findings of the study, explains the potential risks associated with second-stage C-sections, and explores strategies for promoting safer labor and delivery. Empowering expectant parents with knowledge is the first step toward making informed decisions and ensuring the best possible outcomes.

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Measuring Second-Stage C-Sections

A 12-month retrospective observational study gathered data on term, singleton live births from six maternity units to assess the incidence of second-stage cesarean sections and how that incidence can be represented. The supplied study abstract describes the method but does not provide an incidence figure, so a rate cannot be stated from the available material. Second-stage cesarean occurs when delivery by cesarean is required after the cervix is fully dilated, and the source material identifies maternal risk as a concern.

Challenges and Delivery Techniques

Cesarean performed at full cervical dilatation is described as a procedure with distinctive challenges and complications, and the cited commentary reports that its use has risen globally. A chapter on second-stage cesarean says several techniques have been described for delivering the fetal head; it reports fewer complications with the “pull” method than with the “push” method. The chapter also emphasizes training obstetricians in this operation. Counseling should include risks associated with cesarean after a prolonged second stage, although one study’s conclusion cautions that those risks may not be as high as anticipated.

Why Are Second-Stage C-Sections on the Rise?

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Several factors contribute to the increasing rates of second-stage C-sections. These include:

The study from Nepal highlights cephalopelvic disproportion (CPD) – where the baby's head is too large to pass through the mother's pelvis – and fetal distress as the most common reasons for performing C-sections in the second stage of labor. These situations often require a quick decision to ensure the safety of both mother and child.

  • Decreased use of instrumental delivery: Fewer doctors are using forceps or vacuum extraction to assist with vaginal deliveries.
  • Lack of training and supervision: Junior staff may not have sufficient experience in managing difficult deliveries.
  • Concerns about maternal and neonatal morbidity: Doctors may opt for C-sections to avoid potential complications and lawsuits.
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Difficulties and Reported Outcomes

One report explains that as the second stage lengthens, delivery may become more difficult because the lower uterine segment can become edematous, overstretched, and thin, while the presenting part becomes more impacted in the pelvis. A study summary citing Gurung et al. reports uterine-incision extension in 18 cases (12.5%), postoperative fever in 27 (18.8%), and wound infection in 7 (4.8%). Another source describes a decision faced by clinicians between immediate cesarean and attempting a difficult vaginal birth. These findings come from different reports and do not establish that the listed complication rates apply universally.

Comparing First- and Second-Stage Cesareans

The supplied studies frame second-stage cesarean as technically challenging and associated with higher maternal and neonatal morbidity than cesarean earlier in labor. A 2026 study at Hawassa University Comprehensive Specialized Hospital set out to assess adverse maternal and perinatal outcomes for cesareans performed in the first and second stages. A separate 2022 study likewise identifies greater maternal and neonatal risks with second-stage cesarean as its rationale for comparing outcomes. The provided summaries do not include comparative outcome figures, so the size of any difference cannot be specified.

While C-sections can be life-saving, they also carry risks. Understanding these risks is essential for making informed decisions about childbirth.

The Takeaway: Informed Decisions for Safer Deliveries

Second-stage C-sections can present increased risks compared to vaginal deliveries. However, with careful monitoring, skilled healthcare providers, and informed decision-making, these risks can be minimized.

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Balancing Long-Term Tradeoffs

A review comparing cesarean delivery with vaginal delivery concludes that cesarean is associated with lower rates of urinary incontinence and pelvic organ prolapse. It also reports associations with increased risks involving fertility, future pregnancy, and long-term childhood outcomes. These are tradeoffs to weigh together when considering delivery choices; the review’s summary does not quantify the risks.

Research on Subsequent Pregnancy

A population-based cohort study set out to examine whether cesarean during the second stage of labor is associated with preterm birth or cervical insufficiency in a subsequent pregnancy. It also aimed to identify maternal and neonatal risk factors for long-term complications. The available study summary states these research objectives but does not report results, so it does not establish whether such associations were found.

Cesarean as a Public Health Consideration

Cesarean section can be a lifesaving intervention when medically indicated, while also potentially producing adverse short- and long-term health effects for women and children. This framing places cesarean delivery within a broader maternal and child health context, beyond the immediate circumstances of an individual birth. The source does not provide figures or discuss specific system-level drivers.

Preparation for High-Risk Births

A 2026 source concludes that second-stage cesarean sections are accompanied by substantial fetomaternal morbidity. It calls for meticulous surgical technique, skilled operative teams, and comprehensive perioperative preparation to optimize outcomes in this high-risk setting. The source summary does not provide specific complication rates or describe individual patient experiences.

Expectant parents should discuss their concerns and preferences with their healthcare providers. Understanding the potential risks and benefits of both vaginal delivery and C-section is crucial for creating a birth plan that prioritizes the health and safety of both mother and baby.

By promoting normal labor progression, utilizing pain relief measures, and employing effective pushing techniques, healthcare providers can help more women achieve vaginal deliveries and reduce the need for second-stage C-sections. Prioritizing training for instrumental deliveries can also contribute to improved outcomes.

What the complication findings add up to

The reported maternal and neonatal complications show that second-stage cesarean in this cohort involved concerns on both sides of the birth, rather than a single type of outcome.[1]

The findings describe complications observed alongside these procedures; the review does not establish that every listed outcome resulted from the operation itself.[1]

Limits in the study's scope and reporting

  • The report says most women had no instrumental-delivery trial, limiting what this cohort can show about outcomes after attempted instruments.[1]

Patan cohort review of second-stage cesarean

Study designObservational study[1]
PopulationWomen with a singleton, cephalic fetus at term delivered by caesarean section in the second stage of labor[1]
Sample size200[1]
SettingPatan Academy of Health Sciences[1]
DurationApril 1, 2013 to March 30, 2017[1]
Main outcomeSecond stage caesarean section, indications and its maternal and fetal morbidity[1]
Times cited25[1]

How this cohort fits with related evidence

A systematic review and meta-analysis compared cesareans in the first and second stages, reporting higher odds of maternal ICU admission and transfusion for second-stage cesarean; these are relative comparisons, unlike this cohort’s observed complication counts.[2]

The same review reported increased odds of neonatal death and low five-minute Apgar scores, while its estimate for neonatal-unit admission had a confidence interval that included no difference.[2]

A separate comparison found severe maternal morbidity in 2.6% after attempted forceps and 3.7% after second-stage cesarean, but judged the evidence about the effect of attempted forceps very uncertain.[3]

Later authors citing the Patan work refer to its maternal complication observations and describe increasing difficulty as the second stage lengthens, including a more impacted presenting part.[4] [5]

What a follow-up study could clarify

  • How do maternal and neonatal outcomes compare between second-stage cesarean and attempted instrumental delivery in comparable patients?[1] [3]
  • Which outcomes in the cohort were most closely associated with the indication for surgery, such as cephalopelvic disproportion?[1]

Sources

  1. Caesarean Section During Second Stage of Labor in a Tertiary Centre (Nepal Health Research Council, 2017)
  2. First versus second stage C/S maternal and neonatal morbidity: a systematic review and meta-analysis. (pubmed.ncbi.nlm.nih.gov)
  3. Severe maternal and neonatal morbidity or mortality in forceps versus cesarean birth in the second stage of labor: A systematic review and meta-analysis. (obgyn.onlinelibrary.wiley.com)
  4. A STUDY ON THE SECOND STAGE CESAREAN SECTION-MATERNAL AND FETAL OUTCOME
  5. Fetomaternal outcome in caesarean section at full dilatation (2019)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.3126/jnhrc.v15i2.18210, Alternate LINK

Title: Caesarean Section During Second Stage Of Labor In A Tertiary Centre

Subject: General Medicine

Journal: Journal of Nepal Health Research Council

Publisher: Nepal Health Research Council

Authors: Padma Gurung, Sameer Malla, Sushma Lama, Anagha Malla, Alka Singh

Published: 2017-09-15

Everything You Need To Know

1

What exactly is a Second-Stage C-section?

Second-stage C-sections are performed when labor is already well underway, typically during the pushing phase. These procedures involve surgical intervention to deliver the baby after the mother has been in labor for some time. The rising rates of Second-Stage C-sections raise concerns because of potential risks to both mothers and babies, and are influenced by various factors. These factors are instrumental in understanding why this specific type of C-section is becoming more prevalent and how to approach them safely.

2

Why are Second-Stage C-sections becoming more common?

The increasing rates of Second-Stage C-sections are influenced by several factors. A primary reason is cephalopelvic disproportion (CPD), where the baby's head is too large to pass through the mother's pelvis, and fetal distress. Additionally, there's a decreased use of instrumental delivery methods like forceps or vacuum extraction, possibly due to concerns about complications. Lack of training and supervision among junior staff in managing complex deliveries can also play a role. Furthermore, concerns about maternal and neonatal morbidity, as well as the potential for lawsuits, can lead doctors to opt for Second-Stage C-sections.

3

Why is the study conducted in Nepal significant in understanding Second-Stage C-sections?

The study conducted at a tertiary center in Nepal is important as it provides valuable insights into the complexities of Second-Stage C-sections. By analyzing data from over 40,000 deliveries, the research examines the indications for these procedures, the complications that can arise, and the impact on maternal and infant health. This data helps in understanding and optimizing childbirth practices, offering a better understanding of the risks and allowing for strategies to improve safety for both mother and baby.

4

What are the potential risks associated with Second-Stage C-sections?

Potential risks associated with Second-Stage C-sections include increased maternal morbidity, such as higher chances of infection, bleeding, and longer recovery times. For the baby, there can be a higher risk of respiratory issues or other complications related to surgical birth. These risks highlight the importance of careful monitoring and skilled healthcare during labor and delivery. It is important to understand that while Second-Stage C-sections can be life-saving, they also carry inherent risks.

5

How can we ensure safer outcomes during labor and delivery, especially when a Second-Stage C-section is necessary?

To promote safer labor and delivery, it's crucial to make informed decisions. This involves educating expectant parents about Second-Stage C-sections, potential risks, and alternative options. Skilled healthcare providers are essential for careful monitoring and timely intervention. The decreased use of instrumental deliveries, like forceps, underscores the need for training and experience among healthcare professionals. By addressing factors contributing to the rise in Second-Stage C-sections, and focusing on the mother and child, potential risks can be minimized.

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