Seven Cardinal Movement
The cardinal movements of labor are ; engagement, descent, flexion, internal
rotation, extension, external rotation,
and expulsion
Engagement
The mechanism by which the biparietal diameterthe greatest transverse diameter in an occiput presentationpasses through the pelvic inlet is designated engagement.
Descent
This movement is the first requisite for birth of the newborn.
In nulliparas, engagement may take place before the onset of labor, and
further descent may not follow until the onset of the second stage. In multiparous women, descent usually begins with engagement.
Descent is brought about by one or more of four forces: (1) pressure of the
amnionic fluid, (2) direct pressure of the fundus upon the breech with contractions, (3) bearingdown efforts of maternal abdominal muscles, and
(4) extension and straightening of the fetal body.
Flexion
As soon as the descending head meets resistance, whether from the cervix, walls of the pelvis, or pelvic floor, then flexion of the head normally results.
In this movement, the chin is brought into more
intimate contact with the fetal thorax, and the
appreciably shorter suboccipitobregmatic diameter is
substituted for the longer occipitofrontal diameter
Internal rotation
This movement consists of a turning of the head in such a manner that the occiput gradually moves toward the symphysis pubis anteriorly from its original
position or less commonly, posteriorly toward the
hollow of the sacrum. Internal rotation is essential for the completion of labor, except when the fetus is unusually small.
Extension
After internal rotation, the sharply flexed head reaches the vulva and undergoes extension. If the sharply flexed head, on reaching the pelvic floor, did not extend but was driven farther downward, it would impinge on the posterior portion of the perineum and would eventually be forced through the tissues of the perineum.
When the head presses upon the pelvic floor, however, two forces come into play. The first force, exerted by the uterus, acts more posteriorly, and the second,
supplied by the resistant pelvic floor and the
symphysis, acts more anteriorly. The resultant vector is in the direction of the vulvar opening, thereby causing head extension.
This brings the base of the occiput into direct contact with the inferior margin of the symphysis pubis with progressive distension of the perineum and vaginal opening, an increasingly larger portion of the occiput gradually appears. The head is born as the occiput, bregma, forehead, nose, mouth, and finally the chin pass successively over the anterior margin of the perineum Immediately after its delivery, the head drops downward so that the chin lies over the maternal anus.
External rotation
The delivered head next undergoes restitution. If the occiput was originally directed toward the left, it rotates toward the left ischial tuberosity. If it was originally directed toward the right, the occiput rotates to the right. Restitution of the head to the oblique position is followed by completion of external rotation to the transverse position. This movement corresponds to rotation of the fetal body and serves to bring its bisacromial diameter into relation with the anteroposterior diameter of the pelvic outlet. Thus, one shoulder is anterior behind the symphysis and the other is posterior. This movement apparently is brought about by the same pelvic factors that produced internal rotation of the head
Expulsion
Almost immediately after external rotation, the anterior shoulder appears under the symphysis pubis, and the perineum soon becomes distended by the posterior shoulder. After delivery of the shoulders, the rest of the body quickly passes
