Medically reviewed by Dr. Melissa Dennis, MD, MHA, FACOG

If you're pregnant, understanding the cardinal movements of labor can help you feel prepared and empowered as you approach your baby's birth. These seven key movements describe how your baby navigates the birth canal during active labor. Knowing what’s happening behind the scenes can provide reassurance and help you work with your body during this incredible process.

What are the Cardinal Movements of Labor?

The cardinal movements of labor are a series of steps your baby goes through to position themselves for a successful vaginal delivery. Each movement helps your baby's head and body align with your pelvis, ensuring the safest path forward.

As you approach active labor, the baby moves through the birth canal, navigating your pelvis with the help of uterine contractions. The head gradually rotates, flexes, and descends, with cervical dilation allowing for the baby's passage out and into the world. 

The 7 Cardinal Movements of Labor

1. Engagement

Engagement occurs when your baby's head enters the top of the pelvic inlet. In a vertex presentation, baby’s head is now facing down and ready to descend. Engagement typically happens in the final weeks of pregnancy, but may not occur until early or active labor. You may experience increased pelvic pressure and notice your baby bump appearing lower or dropping. Healthcare providers may use Leopold maneuvers or an ultrasound to assess your baby's position.

2. Descent

During active labor, your baby begins to descend, or move further down into the birth canal, guided by uterine contractions. The baby's position is influenced by the shape of the pelvic floor, pubic arch, and pelvic girdle, as well as maternal position. Movements such as pelvic tilts or hands-and-knees positioning can help to open then the pelvis and aid in descent. You’ll have contractions that increase in frequency and intensity as your cervix dilates, often accompanied by pressure in your lower back and pelvis.

3. Flexion

As your baby's head presses against the cervix, it tucks the chin toward the chest, creating a smaller head diameter. This flexion helps the baby move more easily through the narrowest part of your pelvis. Expect to feel building pressure as your cervix nears full dilation (10 cm).

4. Internal Rotation

Your baby rotates their head to align with the widest part of the pelvic inlet. This important shift positions the baby’s head to pass smoothly through the birth canal. Again, you’ll feel an increasing intensity in contractions, possibly with a strong urge to bear down.

5. Extension

As your baby’s head reaches the pubic bone, it naturally extends upward. This motion allows the head to emerge from the vaginal opening, often referred to as "crowning." You might feel a burning or stretching sensation known as the "ring of fire." Controlled breathing techniques can help ease discomfort during this stage.

6. External Rotation (Restitution)

Once the head is delivered, your baby’s head rotates again to align the shoulders for delivery. Time for a deep breath, while you enjoy a brief pause in contractions as your baby's shoulders shift into position.

7. Expulsion

The final movement is the delivery of your baby's body. Typically, with one final push, your baby's shoulders, torso, and legs follow the head, completing the birth process. With that, your baby is fully delivered and you get to meet your little one in-person for the first time. 

Common concerns during the cardinal movements

Sometimes, a baby’s position can make the cardinal movements more challenging. A sunny side up baby, or baby in occiput posterior (OP) position, means that the baby's head is down towards the birth canal, but their face is turned upwards, towards the mother's belly button. A sunny side up baby can be identified by ultrasound or during a cervical exam, after your water breaks, and may lead to a longer labor or increased back discomfort. 

If your provider notices concerns such as abnormal fetal heart rate patterns or delayed progress, interventions like repositioning, breaking your water, monitoring your baby more closely with internal monitors, suggesting Pitocin to help make your contractions stronger, forceps/vacuum assistance, or a Cesarean section may be recommended to ensure a safe delivery.

Supporting your body through labor

To support your body as it guides your baby through these seven movements:

• Stay active with gentle movements like walking or rocking.
• Use positions that open your pelvis, such as squatting or side-lying.
• Practice breathing techniques to stay calm and focused during contractions.

Your care team, including your doula, midwife, L&D nurses, and OB-GYN, will guide you every step of the way. Understanding these cardinal movements,and knowing what to expect, helps you feel informed, empowered, and ready for your baby’s arrival.

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