When in labor, a diagnosis of occipito posterior presentation is made. The most appropriate management in this case would be:

When the fetal occiput fails to spontaneously rotate anteriorly, a persistent occiput posterior presentation results in a more prolonged and painful labor. After waiting for a normal labor, manual, vacuum, or forceps rotation is usually done but increases the likelihood of maternal and fetal injuries. Regional anesthesia can be used to provide perineal analgesia and pelvic relaxation, allowing manual or forceps rotation followed by forceps delivery. Ref: Morgan, Jr. G.E., Mikhail M.S., Murray M.J. (2006). Chapter 43. Obstetric Anesthesia. In G.E. Morgan, Jr., M.S. Mikhail, M.J. Murray (Eds), Clinical Anesthesiology, 4e.