The second stage of labor is arguably the most crucial time in a woman’s labor course. Both maternal and fetal factors play a role in the perinatal outcome of the second stage with fetal position, parity and epidural status being the most important influences. Second stage can be complicated by the maternal issues of prolonged second stage or arrest of descent. Management of the second stage includes decision making regarding maternal position, delayed pushing, pushing technique, expectant management and operative vaginal delivery or cesarean delivery. Ultrasound can be a useful adjunct to the management of the second stage of labor.