Head Floating

Engagement of Fetal Head

• Engagement occurs when the largest
diameter of the fetal head fits into the
largest diameter of the maternal
pelvis.
• As the fetal head engages,the head
moves towards the pelvic brim in
either the left or right occipito-
transverse position.
• This allows the widest part of the fetal
head to fit through the widest part of
the pelvic inlet.
Descent
• Here the baby decends through the
pelvic inlet towards the pelvic floor.
• Decent occurs due to:
> Uterine contractions and retraction.
> Bearing down efforts and
> Straightening of the ovoid fetal

especially after the rupture of the

membranes.
Flexion
• As the fetal head comes into contact
with the pelvic floor, cervical flexion
occurs.
• This allows the presenting part of the
fetus to be sub-occipito bregmatic.
• In this position, the fetal skull has a
smaller diameter, which assists
passage through the pelvis.
• Flexion is achieved either due to the
resistance offered by the unfolding
cervix, the walls of the pelvis or by the
pelvic floor.
Internal Rotation
• The pelvic floor has a gutter shape, with a
forward and downward slope.
• This allows the head to rotate from a left or
right occipito-transverse position to an
occipito-anterior position.
• Thus the prerequisites of internal roatation
of the head are:
> Well flexed head
> Efficient uterine contraction
> Favorable shape at the midpelvic
plane
> Tone of the levator ani muscles.
Crowning
• At this stage, the maximum
diameter of the head stretches
the vulval outlet without any
recession of the head even after
the contraction is over called
‘Crowning of the head’.
Extension
• The occiput slips beneath the
suprapubic arch as the head extends
and the nape of the neck is pivoting
against the arch.
• Extension of the head causes
stretching of the perineum.
Restitution
• When the head is delivering, the
occiput is directly anterior. As soon as
it escapes from the vulva, the head
aligns itself with the shoulders, which
have entered the pelvis in the oblique
position. The slight rotation of the
occiput through one-eighth of a circle
is called ‘Restitution’.
External Rotation
• Movement of rotation of the head
visible externally due to internal
rotation of the shoulders.
• As the anterior shoulder rotates
towards the symphysis pubis from the
oblique diameter, it carries the head
in a movement of external rotation
through one-eighth of a circle in the
same direction of restitution.
Expulsion of the trunk
• After the shoulders are positioned in
anteroposterior diameter of the
outlet, further descent takes place
until the anterior shoulder escapes
below the symphysis pubis first.
• By a movement of lateral flexion of
the spine, the posterior shoulder
sweeps over the perineum. Rest of
the trunk is expelled out by lateral
flexion.