Protracted labor resulting from fetal malposition in the second stage of labor occurs in approximately 5% of patients[1] and is associated with severe perineal lacerations, cesarean hysterotomy extensions, maternal hemorrhage, chorioamnionitis, and neonatal depression. Risk factors for malposition (particularly occiput posterior) such as nulliparity, advanced maternal age, obesity, African American ethnicity, previous occiput posterior delivery, narrow pubic arch, advanced gestational age, fetal macrosomia, and epidural anesthesia are identifiable but seldom modifiable. Manual rotation from occiput posterior or occiput transverse to occiput anterior in the second stage of labor can mitigate maternal and neonatal risks. By correcting fetal malposition via manual rotation for appropriately selected patients, OB/GYN hospitalists can lower the rates of cesarean deliveries and operative vaginal deliveries.