Current obstetric practice lacks clear guidelines regarding the management of a prolonged second stage (PSS). Research suggests increased risks for poor perinatal outcomes with PSS. Finding the balance point between promoting a healthy vaginal delivery and minimizing adverse perinatal outcomes could be instrumental in guiding the management of the second stage. The aims of this project were to 1) examine PSS outcomes for patients cared for by midwives at an academic health center between 2012 and 2019 and 2) determine and act upon opportunities for improvement in clinical and systems approaches to best practice.