Inclusion Criteria:  Pregnant Age 18 years or greater English-speaking Nulliparous Singleton gestation Planning a vaginal birth Have neuraxial anesthesia Term gestation (≥37 weeks' gestation) Ruptured membranes Complete cervical dilation Cephalic presenting fetus Fetus presenting with occiput posterior or occiput transverse position confirmed by ultrasound  Exclusion Criteria:  Pregnancies with intrauterine fetal demise Pregnancies affected by major fetal anomaly Maternal or fetal contraindication to vaginal delivery, including operative vaginal delivery Fetal malpresentation, including brow or face presentation Category III fetal heart rate tracing at time of randomization Duration of pushing already exceeding 15 minutes in the second stage of labor Lack of other inclusion criteria as described above