Standard obstetrical textbooks and journal articles generally do not make a distinction between 2nd stage and the perineal phase. Typically the obstetrical patient is not encouraged to be mobile during active labor, permitted to sit on the toilet for prolonged periods of time during expulsive stage or instructed to assume a vertical posture for delivery. In contrast, midwifery management has traditionally acknowledged the psychological, social and sexual aspects of labor, the influence of gravity, the advantages of maternal mobility and upright postures, birth-specific positions such as squatting and the benefit of facilitating the fetal ejection reflex when possible.
Midwifery management implies the use of the methods listed below.