3.1 Initiation of active pushingA woman should be encouraged to push when full cervical dilatation, the fetal condition, and engagement of the presenting part have been confirmed, and the woman feels an urge to bear down. Even when the woman feels the urge, pushing should only be encouraged during a contraction [4]. In the absence of the urge to push and in the presence of a normal fetal heart rate, care providers should wait before encouraging active pushing in primiparous women and women who have had an epidural for up to but not longer than 4 hours, and in multiparous women for up to but not longer than 1 hour [5], [6]. The basis for this recommendation is that under normal circumstances at the end of the first stage of labor, uteroplacental perfusion and fetal oxygenation only start to deteriorate once active pushing commences.