Objective To assess the duration of the second stage of labor in twin pregnancies in relation to maternal and neonatal outcomes. Methods A retrospective study between 2014 and 2020. Eligible cases were twin pregnancies that reached the second stage. The pre‐defined groups were based on the total time spent in the second stage of labor; Group 1 (<1 h), group 2 (1–2 h), and group 3 (>2 h), which was considered the prolonged second stage group. Results Among the 439 planned vaginal births, successful vaginal delivery of both twins was achieved in 63.8%. Prolonged second stage was observed in 25.8% (89/345). Nulliparity (odds ratio [OR] 7.72, 95% confidence interval [CI] 4.5–13.4) and use of epidural analgesia (OR 5.45, 95% CI 1.2–24.7), were the only independent variables significantly associated with prolonged second stage. Prolonged second stage was associated with a greater risk of intrapartum cesarean delivery (32.6%, P < 0.001), combined delivery (10.1%, P < 0.001), chorioamnionitis (8.3%, P = 0.006) and a admission to neonatal intensive care unit of at least one of the twins (30.3%, P = 0.02). Conclusion Prolonged second stage of labor affects maternal and fetal outcome in twin pregnancies.