Objective: To explore midwives' experiences of managing childbirth with the fetus in the occiput posterior position. Design: Qualitative study using focus groups with midwives. Setting: Six clinics in southeast Sweden. Participants: Twenty-six midwives who took part in six focus groups. Methods: The study was conducted between May and December 2022. Reflexive thematic analysis was used to analyze the interviews, and each focus group consisted of three to six members. Results: The overarching theme, Midwifery in the Face of Uncertainty, and three themes, Putting the Clinical Puzzle Together, Navigating an Unpredictable Birth Process, and Traveling Together, represented the experiences of the participants. The participants put together clinical "puzzle pieces" to assess the position of the fetus, but challenges in accurately determining the occiput posterior position through external palpation highlighted the need for improved skills. The participants navigated unpredictable progress of birth and balanced intervention strategies to encourage rotation, but no single approach guaranteed success. Conclusion: Uncertainty regarding palpation of the fetus, the need for optimal support for women with fetuses in the occiput posterior position, and the need for effective communication emerged as recurring needs throughout the study. Increased understanding of the clinical context of the occiput posterior position and education and training in palpation techniques for midwives and students are essential to promote positive birth experiences.