Clinical interventions during the second stage of labor should not be offered or advised where labor is progressing normally and the woman and baby are well, and should only be initiated when the appropriately trained staff and equipment are in place. Therefore, close attention to the maternal and the fetal condition during the second stage provides the necessary clinical reassurance that no interventions are necessary. If the conditions deviate from normal, options for immediate intervention or referral depending on the care setting should be defined clearly in protocols and guidelines to allow timely access to emergency obstetric and neonatal care. All women require close monitoring during the second stage of labor and service planners need to recognize this in formulating shift plans. With the underpinning of a supportive regulatory framework for professional practice based on competencies, and depending onthe level of the healthcare system at which care is provided, the skilled attendant and the assistant should have access to equipment for instrumental delivery and neonatal resuscitation and should have the appropriate skills to use and assist with the equipment. In settings where only one skilled attendant is available, briefing of relatives, TBAs, or nonclinical staff about their roles is required.