MECHANISM

OF LABOR 
Presented By: GROUP 1
MECHANISMS (CARDINAL
MOVEMENTS) of LABOR

Involves a number of different position

changes to keep the smallest diameter
of the fetal head (in cephalic
presentation) always presenting to the
smallest diameters of the birth canal

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A. ENGAGEMENT
- Engagement is assessed by vaginal & cervical examination.
 FLOATING- if the presenting part is not yet engaged.
 DIPPING- presenting part is descending but has not yet
reached the ischial spines.
0 station- at the level of the ischial spines; synonymous to
ENGAGEMENT
-1 to -4 (Minus stations)- presenting part is above the ischial
spines; -4 is FLOATING
+1 to +4 (plus stations)- presenting part is below the ischial
spines
+3 or +4- presenting part is at the perineum & can be seen if the
vulva is separated; CROWNING; +4, head is at the outlet

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B. DESCENT
 It is the downward movement of the biparietal diameter
of the fetal head to the pelvic inlet.
 Full descent- when the fetal head extrudes beyond the
dilated cervix & touches the posterior vaginal floor.

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C. FLEXION
 As head descends, it meets with the resistant from pelvic
walls and floor which causes increased flexion of the
head. It makes smallest diameter making sub-
occipitobregmatic (face) to be presented.
 Flexion is aided by abdominal muscle contractions during
pushing
 The head flexes as it touches the pelvic floor & the
occiput rotates about 45° until it is superior or just below
the symphysis pubis (AP diameter of the fetal head is
now in the AP plane of the pelvis), the best relationship
between the head & the outlet of the pelvis
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D. INTERNAL ROTATION
 begins at the level of the ischial spine
 With rotation in each contraction, the fetal head
pushes down on the pelvic floor. The rebound
effect supports a small degree of rotation.
Contractions eventually lead to the fetal head
completing the 90-degree turn. This happens in
start of second stage as it moves until it became
visible to the vulva.

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E. EXTENSION
 As the occiput is born, the back of the neck stops
beneath the pubic arch & acts as a pivot for the rest of
the head.
 The upward resistance from the pelvic floor causes the
head to extend.
 The head extends & the foremost parts of the head, the
face & the chin, are born.
 Further descent is halted as the shoulders are too wide
to pass through the pelvic arch at this position.

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F. EXTERNAL ROTATION/ RESTITUTION
 Almost immediately after the head is born, the head
rotates (from the AP position it assumed to enter the
outlet) about 45° back to the diagonal or transverse
position of the early part of the labor.
 This brings the shoulder into an AP position, best for
entering the outlet with the face turned facing one of the
mother’s thighs.
 Anterior portion of the shoulder is born first, assisted by
downward flexion of the infant’s head.

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G. EXPULSION
 Once the shoulders are born, the rest of the body is born
easily because of its smaller size, signifying the end of
the 2nd stage of labor

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Importance of Determining Fetal
Presentation & Position
 Presentations other than vertex- implies CPD,
membranes rupture early, increased risk for fetal
anoxia & meconium staining, long labor
 4 methods to determine presentation, position &
Lie:
 Abdominal inspection & palpation
(LEOPOLD’S MANEUVER),
 vaginal examination,
 auscultation of FHT and
 sonography

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THANK YOU!