Objective: To compare two upright delivery positions at the second stage of labour in healthy primiparous women with regard to duration of the second stage of labour and maternal experience. Design: A randomised controlled trial. Setting: A county hospital delivery ward. Sample: Primiparous subjects (n = 271) were randomly allocated to a kneeling (n = 138) or a sitting (n = 133) position during the second stage of labour. A postpartum questionnaire was answered by 264/271 women (97%) participating in the trial. Methods: Primiparous subjects were randomised to a kneeling or sitting delivery position during second stage of labour. Analysis was performed on an intention-to-treat basis. Main outcome measure: Duration of the second stage of labour. Results: A comparison of the duration of the second stage of labour (kneeling 48.5 minutes +/- 27.6 SD, sitting 41 minutes +/- 23.4 SD) revealed no significant difference between the groups. A sitting position during the second stage of labour was associated with a higher level of delivery pain (P < 0.01), a more frequent perception of the second stage as being long (P = 0.002), less comfort for giving birth (P = 0.03) and more frequent feelings of vulnerability (P = 0.05) and exposure (P = 0.02). There were no significant differences in the frequency of sphincter ruptures although a sitting position was associated with a higher degree of postpartum perineal pain (P < 0.001) (Table 3). Conclusion: Kneeling and sitting upright during the second stage of labour do not significantly differ from one another in duration of the second stage of labour. In healthy primiparous women, a kneeling position was associated with a more favourable maternal experience and less pain compared with a sitting position.