If this your first pregnancy, you no doubt have lots of questions about labor. One I hear often: How long is a reasonable amount of time to push before it's time to worry?
The answer is it depends. If Mom's been pushing for a couple of hours, making progress, still has enough energy and her baby's not showing any signs of distress, most doctors and midwives will support her to continue pushing. The American College of Obstetricians and Gynecologists considers 3 hours or more (especially with a first time mom and/or those with epidurals) to be perfectly normal.
If the mom starts feeling fatigue, taking a pushing break is fine, as long as the baby's okay. Moms with epidurals are sometimes encouraged to "labor down" which means instead of actively pushing, they allow the uterus and contractions to do some of the work for them while they rest. That's tougher on women who don't have epidurals because they're in pain and "laboring down" may extend the amount of time they're painful. If she's truly too worn out to push any longer and baby's nowhere near crowning, this delivery may wind up in the operating room.
We do a lot of fetal heart monitoring in second stage labor (pushing stage) because some baby's have a tough time. If baby's heart is slowing down or speeding up in specific ways that indicate distress, and again, is nowhere near delivery, this may be a situation that calls for a c-section. What if Mom's been pushing and pushing, tried several positions and techniques and baby just won't budge? If baby really won't come out the main exit, it may be time to try the side door.
Oxygen deprivation is a big worry with every delivery. That's why we do so much monitoring. If baby's heart is decelerating (slowing down) in a certain way (we're trained to know the difference between a dangerous deceleration and one that's not), it sometimes means baby's finished being a good sport about labor. It may indicate the placenta's giving out, the umbilical cord's being pinched or yanked or mom's circulation is compromised.
There's a lot we can do to improve those situations without wheeling Mom to the operating room. Repositioning Mom to take pressure off the cord and bumping up her circulation by giving oral or IV fluid are two simple ways we can make huge improvements to baby's blood and oxygen supply. We frequently give Mom extra oxygen through a face mask to ensure she's delivering 100% oxygen to the baby through her own blood.
If those measures don't work well and quickly, we call it quits and go to the Big Room for a c-section. Doctors don't mess around with this sort of thing. That's part of the reason why the c-section rate is so high.