Mechanism of labour

Descent The fetus begins to descend into the pelvis due to the force of gravity and downward pressure of the contractions Relation to practice
Primip-may occur before the onset of labour Multip-not until onset of labour due to laxity of uterine/abdo muscles Educate re optimal fetal positioning Adequate abdominal palpation Upright and mobile once in Labour, continual support
Claire Allan 1

Mechanism of labour
Flexion As the fetus descends the chin touches the chest (arms begin to cross) and the attitude of flexion is adopted. This is increased further when the head meets the resistance of the birth canal Relation to practice Upright position to assist with gravity When resting, adopt the left lateral position (OFP) Observation of the contractions-are they regular, do they appear to be increasing in strength and becoming expulsive?
2

Claire Allan

Mechanism of labour
Internal rotation As the occiput reaches the resistance of the pelvic floor, it rotates forward 45 degrees. The slope of the pelvic floor aids this rotation forward and allows the head to emerge in the longest diameter of the pelvis (anterposteior) Relation to practice
Fully dilated, station of the head Vertex may or may not be visible Upright position-kneeling, squatting May be spontaneously pushing Would you encourage mechanical pushing or allow for natural descent?

Claire Allan

Mechanism of labour
Crowning
The head has crowned when it escapes under the pubic arch and no longer recedes between contractions because the widest transverse diameter of the head is born Extension With slight extension the bregma, forehead, face and chin will pass over the perineum and the head is born

Relation to practice May be spontaneously/mechanically pushing or still breathing through contractions, how long can the second stage last? Introverted in her behaviour and may adopt alternative Position, bending towards the floor with knees apart
Claire Allan 4

Mechanism of labour
Restitution
When the head is born it will turn to the left or the right, righting itself with the shoulders. The shoulders then rotate (similar action to that of the head) and lie in the anteroposterior diameter of the pelvis. Rotation follows the same direction as restitution

Relation to practice No need to do anything, allow time for restitution (you may see a small part of the anterior shoulder). Wait for the next contraction to deliver the remainder of the body (Drs are often too quick in trying to deliver the body)

Claire Allan

Mechanism of labour
Lateral flexion In most supine or semi recumbent birthing positions the anterior shoulder will be born first (under the pubic arch) and the posterior shoulder will pass over the perineum Relation to practice If the woman is on all fours or leaning forward then the posterior shoulder may be born first due to gravity and the effect of the birth canalthe curve of carus-this causes the trunk of the baby to flex sideways as it is born

Claire Allan