BACKGROUND:
A fetus in the occiput posterior position can affect both the progression of labour and the woman’s overall birth experience. Despite this, maternity care lacks standardized guidelines for identifying fetal position and managing births with a fetus in the occiput posterior position to reduce potential complications.

OBJECTIVES:
To explore midwives’ perspectives on labour and birth when an occiput posterior position of the fetus is identified during the birthing process.

METHODS:
This qualitative study was based on focus group interviews conducted between May and December 2022. A total of 26 midwives participated in six focus groups, each consisting of three to six participants. Data were analyzed using reflexive thematic analysis.

RESULTS:
Three themes were constructed: "Putting the Clinical Puzzle Together," "Navigating an Uncertain Birth Process," and "Travelling Together." Midwives described how they pieced together clinical signs to assess fetal position, although it was often difficult to determine through external palpation—highlighting a need for improved assessment techniques. They managed the unpredictability of OP births using a combination of maternal positioning and targeted interventions, yet no single strategy consistently led to fetal rotation. The midwives aimed to support women throughout the experience of an OP birth by providing reassurance, clear communication, and supportive care to help preserve the women’s confidence and understanding.

CONCLUSIONS:
The study highlights the uncertainty surrounding fetal position assessment, the provision of optimal support during OP births, and the timing and manner of informing women about the OP position. These concerns are evident throughout the study.

KEY MESSAGE:
Confirming fetal position can enhance understanding of the birth process. Marginalized - racism