What are the Seven Cardinal Movements of Labor?

What are the Seven Cardinal Movements of Labor?
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Instructor: Wendy McDougal

Wendy has taught high school Biology and has a master's degree in education.

The Seven Cardinal Movements of Labor refer to the varying head positions a fetus undergoes throughout the labor process. These positions help the fetus successfully navigate the maternal pelvis and birth canal. Learn about these positions and quiz yourself at the end.

Definition of the Seven Cardinal Movements of Labor

Pregnancy is a time of extreme change for a woman. Her body grows, stretches, and loosens to accommodate the growing infant taking up space that was previously unoccupied. As the due date approaches, the realization often hits that this relatively large infant must emerge from a relatively small opening. And this opening is not simply a chute through which the fetus glides. It is a somewhat tricky passageway, requiring navigation of a bony pelvis. For this reason, the fetus must also do its part to emerge successfully.

And it does - through a series of small changes in its head position. These positions happen circumstantially, due to the labor process. For example, at times the fetus is being pushed by contractions and simultaneously resisted by the pelvic floor. In addition, it must also negotiate the bony and narrow areas of the pelvis. All of these factors result in distinct fetal positions and movements known as the seven cardinal movements of labor. In this lesson, we'll take a closer look at these positions and understand their importance in the labor process.

The Seven Movements

The seven cardinal movements of labor are: engagement, descent, flexion, internal rotation, extension, external rotation and expulsion. To better remember this long list of terms, try the following pneumonic: Every Day Fine Infants Enter Eager and Excited. This will help in recalling the specific order of the movements. Now, let's look at each one individually.

Technically, the first cardinal movement can happen before actual labor begins. Typically two to three weeks before term, the baby begins to drop. This means that its head is lowering in preparation for birth. It is here that we see the first cardinal movement, engagement. Engagement occurs when the widest part of the fetal head has passed below the maternal pelvic inlet. Essentially, the baby's head has officially entered its mother's pelvis.

As the fetal head continues its downward passage into the pelvis, it enters the second cardinal movement, descent. This is specifically named by its position relative to the ischial spines of the maternal pelvis. These positions are called stations, which range from -5 to +5. The baby is at station 0 when its head is even with the ischial spines. It moves into positive territory as it continues to drop lower into the pelvis.

Once the fetal head reaches +3 station, it finds itself at the soft tissues of the pelvis. At this point we see the third movement, flexion. During flexion, uterine contractions push the fetus downward against the cervix. Its chin becomes tucked, touching its chest as if preparing to do a forward roll. This position allows for the smallest head diameter to pass through the pelvis.

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