Mechanisms of Normal

Labour

Presented by:
Nisha Chand

Definition
The series of movements that occur on the head in the process of
adaptation, during its journey through the pelvis is called
mechanism of labour. It should be in mind that while the principle
movements are taking place in the head, the rest of the fetal trunk is
also involved in it, either participating in or initiating the movement.
Mechanisms:
In normal labour, the head enters the brim more commonly
through the available transverse diameter (70%) which is longest
diameter of the pelvis.

The head which normally enter the brim in the tranverse or

one of the oblique diameters undergoes rotation and also some
changes in its attitude as it passes through the pelvic cavity
and born from pelvic outlet in anterior-posterior diameter
(longest diameter). Left occipito anterior is little common than
right occipito-anterior as the left oblique dimeter is enroched
by the rectum. The principal movement are:
1. Engagement
2. Descent
3. Flexion

4. Internal rotation of head

5. Crowning of head
6. Extension of head
7. Restitution of the head
8. Internal rotation of the shoulder
9. External rotation of the head

occurs in same

time
10. Lateral flexion of the body with expulsion of fetus.

Mechanism of labour in vertex presentation (LOA)

For normal mechanism, the fetus should be on following condition.
i) Lie-should be longitudinal lie.
ii) Attitude: Attitude must be in good flexion
iii) Presentation: Should be vertex or cephalic presentation.
iv) Position: Left occipito-anterior position
v) Denominator: Occiput
vi) Presenting part: Posterior area of right parietal bone or sub occipital
part
vii)Engagement: Head should be well engaged in pelvic brim and cavity.
viii)Station: Should be below the ischial spines.

1. Engagement
In left occipito anterior, fetal head enters pelvic brim with occiput
lying in relation to left iliopectineal eminence, sinciput at right
sacroiliac joint and sagital suture lying on right oblique diameter of
maternal pelvis. The engaging transverse diameter of fetal head is
biparietal 9.5cm and the sub-occipito bregmatic diameter 9.5cm.
When the sagital suture lies anteriorly, the posterior parietal bone
becomes the leading presenting part and is called posterior parietal
presentation. This is more frequently found in primigravidae
because of good uterine tone and a tight abdominal wall.

In others sagital suture lies more posteriorly with

the result that the anterior parietal bone becomes
the leading presenting part and is called anterior
parietal presentation. It is more commonly found in
multiparae. In primigravidae engagement occurs in
a significant number of cases before onset of labour
while in multiparae engagement occur in late first
stage with rupture of the membranes.

2. Descent
Descent is continuous process.It is slow or insignificant in first
stage but pronounced in second stage. It is completed with
expulsion of the fetus. In primigravidae, with prior engagement of
the head, there is practically no descent in first stage, while in
multiparae, descent starts with engagement. Head is expected to
reach the pelvic floor by the time the cervix is fully dilated.
Factors facilitating descent are:
i. Uterine contraction and retraction
ii. Bearing down efforts
iii. Straightenning of the fetal ovoid specially after rupture of
membrane.

3. Flexion
While some degree of flexion of the head is noticeable at the
begining of labour but complete flexion is rather uncommon.
As the head meets the resistance of the birth canal during
descent, full flexion is achieved. Thus if the pelvis is adequate
, flexion is achieved either due to resistance offered by the
unfolding cervix, the walls of the pelvis or by the pelvic floor.
Flexion is essential for descent since it reduces the shape and
sizes of the plane of the advancing diameter of the head.

4. Internal rotation of the

head
Internal rotation is a turning forwards of
whatever part of the fetus reaches the anterior,
lateral half of the gutter shaped pelvic floor
first.