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Introduction: Childbirth is considered one of the most rewarding and memorable experiences in a woman’s life. Labour is the process that leads to childbirth. Difficult labor, characterized by abnormally slow labor progress, is known as dystocia. Malposition refers to any position of the vertex other than flexed occipito-anterior (OA) one. It is a common obstetric belief that progression of labour is underpinned by fetal position. Material and Methods: 100 term antenatal patients, 50 with occipito-posterior (OP), and 50 with an OA position, were included in the study admitted in the labor room from December 2015 to March 2017. After the recruitment of patients, detailed history, examination: general physical, per abdominal and per vaginal was done. All patients underwent ultrasonography to confirm the fetal position at the onset of labor. They were then followed up until birth to determine the outcome. The neonatal outcome was analyzed by Apgar score at 1,5 minutes of delivery, presence of caput succedaneum, and molding. Results: Among total 100 cases, the proportion of vaginal delivery was more in OA group (74%) in comparison with OP group (42%). 40% of patients of OP group landed into cesarean delivery against 18% of patients of the OA group. 8% percent of patients had face to pubis delivery. The mean duration of labor is prolonged in study group i.e., 473.2 ± 1.84 minutes in the first stage, 29.4 ± 7.67 minutes in second stage and 5.70 ± 1.75 minutes in third stage vs. i.e., 376.8 ± 1.26 minutes in first stage, 24.79 ± 9.77 minutes in second stage and 5.20 ± 3.22 minutes in third stage of labor of control group. Conclusion: The group with malposition showed prolongation of labor in comparison to OA position. A higher rate of cesarean delivery was observed in the study group because of preference for cesarean over instrumental delivery. The neonatal outcome was comparable in both groups. Only a few instrumental deliveries were noted because the art of instrumental delivery is dying in modern obstetrics.