Pugh et al. also stressed the critical importance to nursing care delivery of understanding postpartum fatigue factors and levels of fatigue severity. This research also found that the application of different pushing techniques during the second stage of labor could reduce postpartum fatigue severity. Fatigue that arises during the second labor stage can encourage the mother and family members to abandon the natural birth process in hopes that surgery will resolve birthing difficulties. Fatigue can also cloud rational thinking and lead to misjudgments and impatience. Symptoms increasingly affect one another as level of fatigue severity rises. Mother and family member’s confidence that a successful birth will increase if time spent in pushing exertion during the second stage of labor is reduced, and pushing exertion are made more productive. Also, utilizing aids such as mirrors to show fetal head progress to the mother can enhance positive anticipation and joy in the mother and family members, ease the anxiety and discomfort of labor, and reduce fatigue. Therefore, adjusting approaches to care during the second stage of labor can help reduce emotional distress and postpartum fatigue.