In plain words
The cardinal movements of labor are the seven steps a baby's head goes through as it moves down and out of the pelvis. They are engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. Each movement helps the head fit through the bony birth canal. A mother does not need to do anything to make them happen. The way a mother is positioned can change the shape of the pelvis and how the head fits. Many mothers hear about these movements from a or a childbirth class. Not every birth follows the same order. A baby in a different position may turn differently. Clinicians use the movements to follow how labor is progressing.
The deeper version
The cardinal movements of labor (engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion) depend on the fit between the fetal head and the maternal pelvis. Upright and squatting positions can enlarge pelvic outlet dimensions on imaging, while supine positioning reduces them and allows the gravid uterus to compress the inferior vena cava and aorta, lowering maternal cardiac output and uteroplacental perfusion. A Cochrane review of second-stage positioning (Gupta and colleagues, 2017) associated non-supine positions with a shorter , with other outcomes less clear. positions can alter the sequence, particularly internal rotation. The movements are standard in obstetric texts (Cunningham and colleagues, Williams Obstetrics, 26th edition, 2022). Their value for judging progress is debated.
Where it comes up
- Pushing and positions for birthGetting Ready for Birth
- The stages of labor, plainlyBirth and the First Days
- Back labor and baby's positionGetting Ready for Birth
- Signs labor is startingGetting Ready for Birth
- Pain options: from breathing to epiduralGetting Ready for Birth
What mothers here say about cardinal movements of labor
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Sources
- Cunningham FG and colleagues — Williams Obstetrics, 26th edition, 2022
- Gupta JK and colleagues — Position in the second stage of labour for women without epidural analgesia. Cochrane Database of Systematic Reviews, 2017