While the lithotomy position is used extensively in American obstetrical settings, it has been criticized because of the physiological and anatomical compromises it imposes on the mother and her fetus at the time of birth. This paper reviews the variety of positions that may be considered as alternatives to the lithotomy position. It also considers the nature of the parturient's expulsive efforts as an additional factor related to maternal position and influencing the duration of second stage as well as fetal/neonatal and maternal status. As in the first stage of labor, a variety of factors are associated with maternal position in contributing to labor outcome.