Cardinal Movements of Labor

A baby’s position is important for birth to proceed naturally, allowing the smallest part of the baby to present first. In order to position correctly, a baby in the womb will try it’s best to shift into a direction that best facilitates birth.

The movements where the baby shifts themselves into position are known as the seven cardinal movements.


This stage is simply the diameter of the baby’s head into the mother’s pelvic cavity from ear to ear. This is the start of the birthing process and the baby getting themselves into the position for birth.

To speed the engagement process along, sitting on a firm birthing ball moving your hips in a figure-8 motion or performing abdominal lifts during contractions may help.

Descent & Flexion

The baby doesn’t just have to get aligned with the mother’s pelvis, their head must descend deep into the pelvic cavity. Their little body has to begin it’s form to position correctly into the pelvis deep enough for traditional birth.

Flexion and the descent go hand and hand. This movement is the result of the baby’s head hitting the soft tissues of the pelvis, aligning their head with their chin toward their chest at they reach the depth of the pelvic cavity.

Squatting or sitting may help promote the baby’s descent and flexion and make labor a little more comfortable. This is a good opportunity to use birthing stools and balls to make squatting easier and more effective.

Internal Rotation

As the baby’s head reaches the pelvic floor, it’s head will rotate to accommodate changes in the pelvis known as internal rotation. By the time the baby reaches the pelvic floor, their head is almost always fully rotated.

Standing upright and slightly bending the knees as the baby is rotating toward their optimal position in the pelvis will alleviate stress on the mother’s back and the uncomfortable weight of the baby’s descent.


Once the baby is fully rotated and descended, extension occurs when their head passes through the pelvis at the base of the neck. Once extension occurs, the face and head appear outside the body.

Contractions are doing most of the work here and staying comfortable is the best way to keep the mother focused and affirmed through the next few cardinal movements.

This is where your labor doula comes in handy!

External Rotation

Once the head is born, external rotation occurs to alleviate strain on their neck and head from the pelvic muscles. The baby’s face needs to move from face down to either the left or right. This is when the shoulders are fitting through around and under the pubic arch.

By this phase of labor comfort measures such as music therapy, patterned breathing exercises and aromatherapy have likely been exhausted. At this point mom finally has the relief of pushing. The best comfort measure at this point is to keep calm as baby begins his or her exit.


Happy Birthday little one!

Expulsion is the movement where the baby’s shoulders pass the pubic bone and delivered. Once those little shoulders pass through, the whole baby can be delivered in an upward motion.

When the shoulders pass through, the perineum stretches and can sometimes tear. Using a warm compress will relax muscles and help them stretch more gradually as the baby is in the external rotation phase.

Becoming familiarized with the labor process and the cardinal movements can help mothers prepare comfort measures for their delivery. 

You don’t have to navigate and experience these cardinal movements of labor alone. A birth doula assists parents as they prepare for their baby’s due date, keeping them informed with the birth process and fully prepared to stay as comfortable as possible.

 Contact Doulas of Austin and meet your birth doula who will provide continuous support throughout active labor, delivery and the early postpartum period.