The process of labor mechanism has Engagement, Decent, Flexion, Internal Rotation, Extension, Restitution, External Rotation, and Expulsion. In normal labor mechanism, OA position is the normal position for the fetus. The fetal occiput however, may not always present in the OA position, but may also present in the posterior or transverse position. Occiput posterior is the most common abnormal fetal position. Malposition is when the fetal occiput is directed towards the posterior quadrant of the maternal pelvis. The most frequently encountered mal-position is the Persistent Occipito-Posterior (POP) fetal position. Leopolds maneuvers can be very helpful in the diagnosis of OP. FHS are heard in the flank away from the middle line. In this position the maternal spine acts as an inhibitor preventing the head from flexing sufficiently to allow the chin to rest on the chest. The deflexed head with the larger diameter does not fit the pelvis well over the cervix. This causes poor uterine activity that leads to both delayed descent and uneven and slow cervical dilatation. The labor is usually prolonged and mother has increased intensity of back pain. This is also termed back labor. Therefore, the mother may complain of backache and she may feel that her babys bottom is very high up against her ribs. She may report feeling movements across both sides of her abdomen. Nursing interventions such as side-lying position, applying sacral counter pressure, pelvic rocking, help the mother to cope with the back pain. A squatting position helps straighten the pelvic curve and aids in rotation. A maternal hands-and-knees position may help the fetus rotate from a posterior to an anterior positionThe nursing goal is to help the woman relax by adjusting the environment for maximum comfort, establishing a trusting relationship with the mother and family and using pharmacologic and non-pharmacologic methods of pain management.