MECHANISM OF LABOR IN ENGLISH

                                                   

                                  MECHANISM OF LABOR IN ENGLISH

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Mechanism of labor

The series of movements that occur on the head in the process of adaptation during its journey through the pelvis is called mechanism of labor. It is just a guide for midwives may not suite to every delivery because each labour is unique.

In this class we will discuss mechanism for normal labor in which-

• the lie is longitudinal

• the presentation is cephalic

• the position is right or left occipitoanterior

• the attitude is one of good flexion

• the denominator is the occiput

• the presenting part is the posterior part of the anterior parietal bone.

 

Mechanism of labor can be learnt with the world EDFICEREE

(1) Engagement,

(2) Descent,

(3) Flexion,

(4) Internal rotation,

(5) Crowning,

(6) Extension,

(7) Restitution,

(8) External rotation

(9) Expulsion of the Shoulder/trunk.

 

(1) Engagement- engagement is the process by which the widest part of the baby's head (the biparietal diameter) passes through the pelvic inlet, meaning it has descended into the mother's pelvis. Successful engagement indicates that the pelvis is large enough for the baby to descend further

 (2) Descent- Descent is the process where the baby's head, or presenting part, moves downward through the maternal pelvis and into the birth canal. If there is no undue bony or soft tissue obstruction, descent is a continuous process. It is slow or insignificant in first stage but pronounced in second stage. It is completed with the expulsion of the fetus.

 (3) Flexion- flexion at neck is achieved either due to the resistance offered by the cervix, the walls of the pelvis or by the pelvic floor. It has been seen that flexion precedes internal rotation or at least coincides with it. Flexion is essential for descent, since it reduces the shape and size of the plane of the advancing diameter of the head.

 (4) Internal rotation- Internal rotation in labor is the process where the fetal head pivots inside the mother's pelvis, typically from an occipitolateral (ROA or LOA) position to an occipitoanterior position, to align its longest diameter with the widest part of the pelvic outlet. 

 (5) Crowning- Crowning is a stage in the mechanism of labour where the largest part of the baby's head is visible through the vaginal opening and no longer recedes between contractions. It occurs in the second stage of labour after the cervix is fully dilated.

 (6) Extension- Delivery of the head takes place by extension through “couple of force” theory. The driving force pushes the head in a downward direction while the pelvic floor offers a resistance in the upward and forward direction. The downward and upward forces neutralize and remaining forward thrust helping in extension

 (7) Restitution- It is the visible passive movement of the head due to untwisting of the neck sustained during internal rotation. Movement of restitution occurs rotating the head through one-eighth of a circle in the direction opposite to that of internal rotation

 (8) External rotation- It is the movement of rotation of the head visible externally due to internal rotation of the shoulders. As the anterior shoulder rotates toward the symphysis pubis from the oblique diameter, it carries the head in a movement of external rotation through one-eighth of a circle in the same direction as restitution.

 (9) Expulsion of the Shoulder/trunk.- After the shoulders are positioned in anteroposterior diameter of the outlet, further descent takes place until the anterior shoulder escapes below the symphysis pubis first. By a movement of lateral flexion of the spine, the posterior shoulder sweeps over the perineum. Rest of the trunk is then expelled out by lateral flexion.