Mechanism of Labor

Al_ Iraqia University College Of Medicine

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Tabarak Taha Nasser ___________________June 14, 2020

Definition of (Normal) labor: Spontaneous delivery through the natural passages of a

Matura Single Alive fetus presenting by the Vertex (OA) with No interference (+ episiotomy) /
no complication within reasonable time * NB maturity is considered at → (completed 37 wks).

Theories of onset of labor:

1- ↑Prostaglandin →stimulate contractions (most accepted).
2- ↑Oxytocin→ present of head on cx → release from pit (Ferguson reflex).
3- ↑ Estrogen and / or ↓ progesterone.
4- Placental ischemia→ release of uterotonins (PG, oxytocin).
5- Uterine Over Distention → reflex contractions.

DEFINITION OF MECHANISM OF LABOR:

The series of movements that occur on the head in the process of adaptation, during its
journey through the pelvis, is called mechanism of labor. It should be borne in mind that
while the principal movements are taking place in the head, the rest of the fetal trunk is also
involved in it, either participating in or initiating the movement.

In normal labor the head enters the brim more commonly through the available transverse
diameter (70%) and to a lesser extent through one of the oblique diameters. Accordingly, the
position is either occipitolateral or oblique occipitoanterior. Left occipitoanterior is little
commoner than right occipitoanterior as the left oblique diameter is encroached by the
rectum. The engaging antero-posterior diameter of the head is either suboccipito-bregmatic
9.5 cm (3¾") or in slight deflexion—the suboccipitofrontal 10 cm (4"). The engaging
transverse diameter is biparietal 9.5 cm (3 ¾").

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 The principal movements in occipitoposterior position are:
(1) Engagement.
(2) Descent.
(3) Flexion.
(4) Internal rotation.
(5) Crowning.
(6) Extension.
(7) Restitution.
(8) External rotation.
(9) Expulsion of the trunk.

1- Descent
- This step occurs continuously during the labor process due to uterine contraction &
retraction Auxiliary forces.
- Most of the descent occurs near head delivery
(Deceleration phase).

2-Engagement
Passage of the widest transverse diameter of the presenting part (biparietal = 9.5)
below the plane of pelvic brim Known by
- History of (Lightening / Shelfing)
- The head is not felt abdominally above symphysis pubis or only 1/5 – 2/5 is felt
- P/V →The vertex is at / below the level of the ischial spines
→large caput may give false impression of lower station.

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3-Increased flexion:
- To bring 1st the occiput to the pelvic floor
This could be explained by two theories:

1- The head meets the resistance of the pelvic floor (levator ani) →↑ flexion due to the
2 armed lever action.

NB The head acts as a lever with a fulcrum at the atlanto-occipital joint. The short arm is
from this joint to the occiput, the long arm is to the sinciput When head meets resistance
during descent, the force applied to the long arm is > from that on short arm → ascent of
sinciput & descent of occiput .

2- Accommodation Theory: to Allow the shortest long diameter of head (sub-occipito-

bregmatic 9.5 cm) to pass through pelvis.

4- Internal rotation: To allow the longitudinal diameter of the head to pass in

the longest Diameter of the pelvic outlet as the pelvic inlet is transverse oval while outlet
is longitudinal oval.
This could be explained by two theories:

1- The occiput meets pelvic floor 1st → rotates forwards 1/8 of circle.
2- Accommodation theory → the slope & shape of pelvic floor (down, medial,
forward)→acts by a screw (rifling) action on the fetus.

5- Extension: The head descends till the suboccipital region hinges below
symphysis pubis followed by extension with birth of the head (crowning is by the sub-
occipito-frontal: 10cm).

6- Restitution: The head will rotate 1/8 of a circle (in an opposite( direction) to
untwist the neck.
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7-Extemal rotation:
The head will rotate a further 1/8 of a circle so that the face looks to
one side this is because the shoulders enter the pelvis in the opposite
oblique diameter with anterior internal rotation 1/8 of a circle which is
accompanied by external rotation of the head.

8-Delivery of the shoulders:

The anterior shoulder hinges below the symphysis pubis followed
by delivery of the Post shoulder 1 ST by lateral flexion then the
Ante shoulder follows.