Midwifery practice is grounded in optimising physiological processes while responding safely to complications (Nursing and Midwifery Council (NMC) 2019). During childbirth, the diagnosis of labour dystocia, often labelled as ‘failure to progress’, is itself poorly defined in the literature and often a contributory factor in the medicalisation of birth (Weckend et al 2024, 2025). However, midwives are well-positioned to support physiological birth, using non-invasive approaches that can restore progress and reduce unnecessary escalation (O’Brien et al 2022). Reflection provides an essential mechanism for consolidating and sharing such practice.

This reflection presents an account of caring for a woman* whose labour was complicated by an asynclitic fetal head and lack of cervical dilatation. Using biomechanics-informed strategies acquired through a Biomechanics for birth course with Molly O’Brien at Optimal Birth, I was able to support her labour physiology, resulting in a vaginal birth. Biomechanics of birth refers to the physical forces and mechanical processes involved during labour and birth. It encompasses the relationship and interaction between the birthing person’s body and the fetus, to support the process of childbirth (Topalidou 2024). This reflection focuses on how biomechanical strategies can support physiological labour while exploring alignment, movement and advocacy for proportionate care.

*Name has been changed to ensure anonymity.