CARDINAL MOVEMENTS OF LABOR

1) ENGAGEMENT
Descent of the biparietal diameter.
Entering of the widest diameter, (biparietal diameter -
measuring ear tip to ear tip across the top of the baby’s
head), of the fetal presenting part through the plane of
the pelvis/pelvic inlet.
The head is said to be engaged if the leading edge is at the
level of the ischial spines (which is also known as fetal
station 0)

2) DESCENT
Movement of the head into the pelvis.
Movement deep into the pelvic cavity or the downward
passage of the presenting part through the bony pelvis.
When the occiput is at the level of the ischial spines, it can
be assumed that the widest diameter of the baby’s head is
engaged - descent occurs after this happens.
During descent the fetus move downward into the pelvic
cavity

3) FLEXION
Fetal chin flexes to chest
Occurs during descent because of the resistance of the
soft tissues in the pelvis against the baby’s head.
This resistance causes flexion of the head (chin to chest).
This is when the smallest diameter of the baby’s head
presents into the pelvis

4) INTERNAL ROTATION
Rotation of the fetal head from occiput transverse to
occiput in either an anterior or posterior position.
As the head reaches the pelvic floor, it rotates so that the
sagittal suture is in the anteroposterior diameter of the
outlet. This means that the shoulders will pass through the
wides part of the pelvic inlet, which is from right to left.
Remember:
At the pelvic inlet, the diameter of the pelvis is
widest from right to left.
At the pelvic outlet, the diameter is widest from
front to back
 5) EXTENSION
At the end of internal rotation when the baby is at the
level of the vaginal introitus.
This is the point when the birth canal curves
upward. Head, face and chin curve up under and past the
pubic symphysis
You can also think of this as when the occiput is just past
the level of the pubic symphysis and when the head, face
and chin curve under and past the pubic symphysis and
are born.
The baby is still in a antero-posterior position

6) EXTERNAL ROTATION (RESTITUTION)

There is a short pause during labor after the head is
born. During this pause, the baby needs to rotate from a
face-down position to facing either one of the mother's
inner thigh's.
This movement aka restitution, is necessary for the
shoulders to fit under the pubic arch. Remember that
the widest space in the pelvic outlet is in the anterior-
posterior position.
When the head is delivered in the ideal position, (either
left occiput transverse or right occiput transverse), the
baby’s shoulders are positioned anterior-posterior which
is the widest diameter of the pelvic outlet.
This is the point when you would notice a shoulder
dystocia.

7) EXPULSION
Anterior shoulder delivers first, followed by the posterior
shoulder
Delivery of the Anterior Shoulder
Almost immediately after external rotation, the anterior
shoulder moves out from under the pubic symphysis
Delivery of the Posterior Shoulder and Body
Delivery of the posterior should follows delivery of the
anterior shoulder followed by the rest of the body with
an upward motion of the baby’s body by the care
provider.
 ESSENTIAL INTRAPARTUM AND
NEWBORN CARE

ENC is a simple cost-effective newborn care intervention that can improve

neonatal as well as maternal care. It is an evidence-based intervention that:
1) emphasizes a core sequence of actions, performed methodically (step -by-step);
2) is organized so that essential time bound interventions are not interrupted; and
3) fills a gap for a package of bundled interventions in a guideline format

The EINC practices are evidenced-based standards for safe and quality care
of birthing mothers and their newborns, within the 48 hours of Intrapartum period
(labor and delivery) and a week of life for the newborn.

The EINC practices during Intrapartum period

 Continuous maternal support, by a companion of her choice, during labor and
delivery
 Mobility during labor – the mother is still mobile, within reason, during this stage
 Position of choice during labor and delivery
 Non-drug pain relief, before offering labor anesthesia
 Spontaneous pushing in a semi-upright position
 Episiotomy will not be done, unless necessary
 Active management of third stage of labor (AMTSL)
 Monitoring the progress of labor with the use of pantograph
 Recommended EINC practices for newborn care are time-bound
interventions at the time of birth
• Immediate and thorough drying of the newborn
• Early skin-to-skin contact between mother and the newborn
• Properly-timed cord clamping and cutting
• Unang Yakap (First Embrace) of the mother and her newborn for early
breastfeeding initiation

Unnecessary interventions eliminated

The unnecessary interventions during labor and delivery, which do
not improve the health of mother and child, are eliminated. These are enemas
and shavings, fluid and food intake restriction, and routine insertion of
intravenous fluids. Fundal pressure to facilitate second stage of labor is no
longer practiced, because it resulted to maternal and newborn injuries and
death.
Likewise, the unnecessary interventions in newborn care which include routine
suctioning, early bathing, routine separation from the mother, foot printing,
application of various substances to the cord, and giving pre-lacteals or
artificial infant milk formula or other breast-milk substitutes.

Government and international Support

Since 2010, WHO supports the DOH in changing practices for safe
and quality care of mothers and newborns for all practitioners and health
facilities. It was initially implemented in 11 selected government hospitals
collectively representing about 70,000 annual live births (around 3% of all
national live births). AusAID also provided support through the Joint
Programme on Maternal and Neonatal Health (JPMNH).