Traditionally, the lithotomy position is the most commonly used birthing position in western cultures. The purpose of this literature review was to examine the differences in maternal and neonatal outcomes when alternative labor positions are used. Implications for future use of alternative labor positions were explored. Peer reviewed, English-language research articles published from 2009 to 2015 were included for synthesis. Study results revealed that the lithotomy position is linked to multiple negative maternal outcomes. Birthing in a water pool or in a lateral position has been linked to more optimal maternal and neonatal outcomes compared to other positions. Health care providers, and nurses in particular, should be educated on the benefits and consequences of both the lithotomy position and alternative labor positions. Using this evidenced based research, health care professionals can educate women and families as they encounter the birthing process. Further research is needed to identify additional birthing outcomes of labor positions, specifically neonatal outcomes of the lithotomy position. In addition, research on innovative obstetric monitoring techniques will expand the opportunity to use alternative labor positions while protecting the mother and fetus.