Mechanism of labour

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.
Mechanism of labor, or the cardinal movements of labor, refers
to the changes in position of the fetal head during passage
through the birth canal in the vertex presentation

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 diameter. Vertex is the
presentation either on LOA or ROA position.

For normal mechanism, of the fetus should be on following

condition.
a) Lie – should be longitudinal lie.
b) Attitude – attitude must be in good flexion.
c) Presentation – should be vertex or cephalic presentation.
d) Position – ROA, LOA.
e) Denominator – occiput.
Engagement – head should be well engaged in pelvic brim and
cavity.
• As the ROA, LOA are the commonest position. The
mechanism of labor or cardinal movement in such position
are as follows:-
1. Engagement.
2. Descent.
3. Flexion.
4. International rotation of the head.
5. Crowning of the head.
6. Extension of the head.
7. Restitutions of the head.
8. International rotation of the shoulder.
9. External rotation of the head.
10. Lateral flexion of the body with the expulsion of fetus.
1. Engagement: when the biparietal diameter of the head
(9.5cm) passes the pelvic inlet, the head is said to be engaged
in the pelvic inlet.
 In primigravida, engagement occurs in a significant number of
cases before the onset of labour but in multipara engagement
occurs during labour
Passage of the widest diameter fetal presenting part below the
plane of the pelvic inlet
The head is said to be engaged if the leading edge is at the
level of the ishial spines.

2. Descent: - descent refers to the progress of the presenting

part through the pelvis. Descent is a continuous process. It is
slow in first stage but rapid in second stage of labour. Factors
facilitating descent are:-
A) Uterine contraction and retraction.
B) Bearing down effort by women.
C) Straightening of fetal head especially after rupture of
membrane and full dilation of cervix.
• As the fetal head engages and descends, it assumes an
occiput transverse position because that is the widest pelvic
diameter available for the widest part of the fetal head
3. Flexion; while descending through the pelvis, the fetal head
flexes so that the fetal chin is brought into more intimate
contact with the fetal thorax, and the shorter suboccipito-
bregmatic diameter is substituted for the longer occipito-
frontal diameter.
This functionally creates a smaller structure to pass through
the maternal pelvis. When flexion occurs, the occipital
(posterior) fontanel slides into the center of the birth canal and
the anterior fontanel becomes more remote and difficult to
feel.
Causes of Flexion
-The liver theory when the head meets with the resistance of
the pelvis and pelvic floor, the flexion is increased.
-The wedge shape of head

4. Internal Rotation of the head:

With further descent, this movement consists of a turning of
the head in such a manner that the occiput gradually moves
toward the symphysis pubis anteriorly from its original
position.
During the contraction the leading part is driven down ward in
to the pelvic floor. In well flexed vertex presentation the
 occiput leads and meet the pelvic floor and rotate interiorly
through 1/8 of circle
5. Crowning of the head;-
After internal rotation of the head, the occipital prominence of
fetal head lies underneath the symphysis pubis and the small
suboccipito bregematic diameter i. e 9.5 cm appears in the
volval orifice .This is called crowning. The head appears during
contraction at first no longer records between contraction but
later it remains in the volval orifice and expels out more due to
force contraction.
6. Extension
With progressive distension of the perineum and vaginal
opening, an increasingly larger portion of the occiput gradually
appears. The head is born as the occiput, bregma, forehead,
nose, mouth, and finally the chin pass successively over the
anterior margin of the perineum (over the maternal anus).
7. Restitutions:
Restitutions is the visible passive movement of the head.
Restitution is a movement made by the head following delivery
which brings it into correct alignment with the shoulders.
This will be 1/8 th of a circle towards the side from which it
started. . After this movement the occiput points to the
 maternal thigh of the corresponding side to which it originally
laid.
8. Internal rotation of the shoulder . The anterior shoulder
rotates about one eight of a circle towards the symphysis
pubis from the oblique diameter. The shoulder lies in the
anterior posterior diameter of the pelvic outlet. The occupit
points directly towards the maternal thigh corresponding to
the side to which it originally directs at the time of
engagment.

9. External Rotation of the head : The shoulders rotate into an

oblique or frankly anterior-posterior orientation with further
descent. This encourages the fetal head to return to its
transverse position. This is also known as restitution chest.

10. Lateral flexion of the body: For the decent takes place after
the shoulder is positioned in anterior –posterior diameter of
the outlet. It continuous until the anterior shoulder escapes
below the symphysis pubis by the first lateral flexion towards
the mother anus and then secondly the posterior shoulders to
be swept from the perineum. The rest of the body and trunk is
born by lateral flexion of body towards abdomen