Upright positions are recommended by many international organizations due to their positive effects on improving birth outcomes. The effects can only be achieved when upright positions are properly adopted by women under the guidance of midwives. However, whether midwives in China have a clear understanding of upright positions during the second stage of labour is an issue that has not been explored. The aim of this study was to explore midwives' perceptions on assisting women in upright positions during the second stage of labour in the context of China. A qualitative descriptive design was adopted. We analysed the data using the conventional content analysis and reported the study in line with the COREQ checklist. The study was conducted at the labour wards of two maternity hospitals and two general hospitals in China where the adoption of upright positions was encouraged during the second stage of labour. Semi-structured individual interviews with 17 midwives were conducted between May and July 2020. Three main themes were identified: (1) safety and availability; (2) unclear method of implementation; (3) lack of knowledge of the potential risks and precautions. Midwives' perceptions were based primarily on clinical experience rather than evidence-based practice. Their perceptions on the indications and contraindications of upright positions were divergent and ambiguous. Midwives' suggested that the indications and contraindications should be adjusted in the context of China. Time limit for keeping an upright position and maternal pushing during uterine contractions were two questions that still confused midwives. Midwives lacked knowledge of the potential risks of upright positions and rarely systematically summarized the precautions. This study shows that assisting women to give birth in upright positions during the second stage of labour can be a challenge for midwives in China, and also highlights the need for clarifying the detailed implementation methods of upright positions in the context of China by evidence-based approaches. An evidence-based protocol for implementing upright positions during the second stage of labour should be developed to guide midwives' practice and facilitate the successful use of upright positions in China. Copyright © 2021. Published by Elsevier Ltd.