Objective To investigate the present situation of free posture labor in China and analyze the reasons why it is not carried out, so as to provide references for developing appropriate midwifery training and formulating relevant intervention measures in the future. Methods A self-designed questionnaire was used to investigate the current situation of free posture labor in 1 213 medical institutions in 22 provinces, municipalities or autonomous regions. Results Of the 1 213 medical institutions, 1,138 (93.8 %) carried out free posture labor, of which 473 (41.6%) practiced free posture labor in the first stage, and 19 (1.7%) practiced in the second stage alone. The main reasons for not carrying out free posture labor at the first stage included understaffing（46.8%）, insufficient space（31.9%） and safety concerns（45.7%）. The main reasons for not carrying out free posture labor at second stage included safety concerns（51.5%）, midwives untrained for free posture labor（53.1%）, and understaffing（43.1%）. Conclusion The practice of free posture labor in China is uneven. We should beef up support in staffing, space and professional skills.