JOANNE BERNADETTE C.

AGUILAR BSN-2
Mechanisms (Cardinal Movements) of Labor

- Effective passage of a fetus through the birth canal involves not only position and presentation but
also a number of different position changes in order to keep the smallest diameter of the fetal head(in
cephalic presentation) always presenting to the smallest diameter of the pelvis. These position changes
are termed the cardinal movements of labor: descent, flexion, internal rotation, extension, external
rotation and expulsion

1. Descent – Descent is the downward movement of the biparietal diameter of the fetal head within the
pelvic inlet. Full descent occurs when the fetal head protrudes beyond the dilated cervix and touches
the posterior vaginal floor. Descent occurs because of the pressure on the fetus by the uterine fundus.
As the pressure of the fetal head presses on the sacral nerves at the pelvic floor, the mother will
experience the typical “pushing sensation”, which occurs with labor. As a woman contracts her
abdominal muscles with pushing, this aids descent.

2. Flexion – As descent is completed and the fetal head touches the pelvic floor, the head bends
forward onto the chest, causing the smallest anteroposterior diameter (the suboccipitobregmatic
diameter) to present to the birth canal. Flexion is also aided by abdominal muscle contraction during
pushing.

3. Internal rotation – During descent, the biparietal diameter of the fetal skull was aligned to fit
through the anteroposterior diameter of the mother’s pelvis. As the head flexes at the end of descent,
the occiput rotates so the head is brought into the best relationship to the outlet of the pelvis, or the
anteroposterior diameter is now in the anteroposterior plane of the pelvis. This movement brings the
shoulders,coming next, into the optimal position to enter the inlet, or puts the widest diameter of the
shoulders (a transverse one) in line with the wide transverse diameter of the inlet.

4. Extension – As the occiput of the fetal head is born, the back of the neck stops beneath the pubic
arch and acts as a pivot for the rest of the head. The head extends, and the foremost parts of the head,
the face and chin, are born.

5. External Rotation – In external rotation, almost immediately after the head of the infant is born, the
head rotates a final time (from the anteroposterior position it assumed to enter the outlet) back to the
diagonal or transverse position of the early part of labor. This brings the aftercoming shoulders into an
anteroposterior position, which is best for entering the outlet. The anterior shoulder is born first,
assisted perhaps by downward flexion of the infant’s head.

6. Expulsion – Once the shoulders are born, the rest of the baby is born easily and smoothly because of
its smaller size. This movement called expulsion, is the end of the pelvic division of labor.