MECHANISM

OF
LABOUR
 Mechanism of Labor
Positional movements the fetus undergoes
to accommodate itself through the
maternal pelvis
• Engagement: BIPARIETAL DIAMETER of
fetal skull has passed through the pelvic brim
• Descent
• Flexion
• Internal rotation
• Extension
• Restitution
• External rotation
• Birth of the shoulders
• Delivery of the trunk by lateral flexion
1. Head floating before engagement
Engagement

If the widest diameter has entered or

passed through the brim the head is usually
fixed and is described as engaged in the
brim.

It may occur in the last few weeks of

pregnancy or only in labour especially in
multipara
Mechanism of labour with vertex presentation
The term mechanism refers to the series of changes
in position, and attitude which the fetus undergoes
during its passage through the birth canal.
When the head is descending it makes 5
movements
1.Flexion
2.Internal rotation
3.Extension
4.Restitution
5.External rotation
2. Engagement, descent, flexion
3. Further descent with internal rotation
Descent : after engagement head descends
further so that it will favour flexion.
During the first stage and the first phase of
the second stage of labour, descent of the
head is secondary to uterine contraction.

In the second phase of the second stage of

labour, descent of head is helped by
voluntary use of the abdominal muscles and
the Vulsalva manoeuvre ( pushing)
Flexion: as the head enters the narrow mid-
cavity, flexion should occur.

This is due to surrounding structures and

important to minimize the diameter of the
fetal head.
Internal rotation: the leading point ,occiput
reaching the sloping gutter of the levator ms which
contract to make the head rotate anteriorly so that
the sagital suture lies in the AP diameter of the
pelvic outlet.
long internal rotation will take increased duration If
engaged in the OP position of labour with the
malposition.
Alternatively OP may persist and will deliver in mento
anterior “ face to pubes” position.[ face delivery]
Sometimes OP with extended head will lead to
obstructed labour and the need for instrumental or
C section.
4. Complete rotation, beginning extension
5. Complete extension
The head further extends and the occiput
which is underneath the symphysis acts as
a fulcrum point as the bregma, face and
chin appear in succession over the
posterior vaginal opening and perineal
body.

The extension movement minimize soft

tissue trauma by utilizing the smallest
diameters of the fetal head for the birth.
6. Restitution (external rotation)
Restitution: as soon as the head escapes from
the vulva, the head alligns itself with the
shoulders,which have entered the pelvic inlet
in the oblique position. Rotation of head 1/8 of a
circle is restitution.
External rotation: further rotation of 1/8 of a circle
so that the shoulders will be in direct AP position and
the occiput will be on a transverse plane.
7. Delivery of anterior shoulder
Anterior shoulder which is under the
symphysis will be delivered first followed
by the posterior shoulder.

The rest of the body will be delivered with

flexion towards maternal abdomen.
8. Delivery of posterior shoulder