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A significant relationship in
midwifery/obstetrics
Fetal head is large in comparison to the
maternal pelvis
The fetal skull can adapt
Maternal pelvis has limited ability to adapt

2 innominate bones
Sacrum
Coccyx
Each innominate bone consists of three fused
bones
Illium
Ischium
Pubis

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Only mammal to habitually walk upright

Complicated mechanism of labour
Evolution from straight cylindrical passage to a
tilted conical birth canal

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From left to right: chimpanzee, Lucy (Australopithecus

afarensis, 3.2 my), Homo erectus (1.5 my), Homo sapiens.
Note that chimpanzee pelvis has larger AP than ML diameter,
then evolves to wider pelvis in Lucy, and from H. erectus
pelvis is again increasing in AP diameter by differential
growth of the pubic bones. Red asterisk marks ischial spine in
Homo pelvis (adapted from Simpson 2008, with permission
from AAAS).

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Obstetric history
Pelvic history
Fetal considerations

Three sections
Vault five bones (2 frontal, 2 parietal, 1
occipital)
2. Base five bones (2 temporal, 1 ethmoid, 1
sphenoid, part of the occiput)
3. Face 14 bones (fused)
1.

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Incomplete ossification
Ability to mould
Reduced diameters

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Three parts
Brim
2. Cavity
3. Outlet
1.

AP

OBLIQUE

TRANSVER
SE

BRIM

11

12

13

CAVITY

12

12

12

OUTLET

13

12

11

As the fetus descends, soft tissue and bony

structures exert pressures which force the fetus
to negotiate the birth canal by a series of
passive movements known as the mechanisms
of labour. This allows the fetus to take
advantage of the widest diameters of the
pelvis.
EDFIERRE

The presenting part descends into the brim of

the pelvis

35-40 Weeks Primipara (lightening)

37-onset of labour in multipara

V.E. station

Palpation - 5ths above the brim

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Occurs throughout labour

More rapid during 2nd stage

This increases throughout labour

Pressure from descent and contractions cause
flexion ( chin on chest )
This decreases the diameters of the skull to
better suit the diameters of the pelvis
Generally the occiput is the leading part

Occurs when the pp meets resistance from the

pelvic floor
Resistance causes rotation
Resistance is crucial
Fetal head is no longer aligned with the body
Occiput is trapped beyond pubic bone, known
as crowning

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Head is born by extension

Brow and face sweep the perineum

Chin extends past the perineum

Fetal head realigns with the body

Shoulders rotate into the AP diameter

This causes the head to rotate

Delivery of the shoulders is by lateral flexion

Anterior shoulder emerges 1st

Lateral flexion occurs

Posterior shoulder emerges

Remainder of body follows

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Learning the mechanisms of labour allows the

midwife to be aware when the normal is not
occurring and to act on this
Many factors effect the normal mechanisms of
labour ( parity, pain relief, pelvis, presentation )