The pelvis is not a straight tube — its inlet is widest transversely and its outlet widest anteroposteriorly — so the fetus has to turn as it travels. Place the seven cardinal movements in order and watch the head do it. Then run a labour clock that separates latent from active and puts the arrest criteria to the test, and finish in the fourth stage, where fundus, lochia and bladder carry the greatest preventable mortality of the whole birth.
Choose a bench
Select the movements in the order they occur. Each correct placement advances the diagram on the right. A wrong choice tells you which movement has to happen first, and why.
Placed without an error0 / 7
Parity
6 cm
2 h
1 h
Contemporary practice divides the first stage at 6 cm. Historic curves demanding 1.2 cm per hour in a nullipara overestimate normal speed, and a long latent phase alone is not a reason for caesarean birth.
Uterine tone on palpation
Height of the fundus
Midline or deviated?
Lochia
Schedule drill — when is the next check due?
Read the clock on the right, then choose.
Schedule calls correct0 / 0
Nothing placed yetThe fetus is at the pelvic inlet, occiput transverse
The pelvis makes the fetus turn
The inlet is widest side to side and the outlet widest front to back, so a fetus that entered facing sideways must rotate about 45 degrees on the way down. These seven passive movements are what that rotation looks like from outside.
First stage, active phaseSet the clock on the left
Birth of the infant to expulsion of the placenta, normally within 5 to 30 minutes. Four signs say it has separated: a firm globular uterus, a rise of the fundus in the abdomen, lengthening of the visible cord, and a sudden small gush of blood. Shiny fetal side first is Schultze; dull maternal side first is Duncan. Active management — a uterotonic such as oxytocin 10 units IM or 10 to 40 units in 500 to 1000 mL of isotonic fluid IV, gentle controlled cord traction with counter-pressure above the symphysis, and fundal massage after the placenta delivers — roughly halves the risk of haemorrhage. The placenta is then inspected for completeness, because retained fragments are a classic delayed cause of bleeding.
The fourth stage schedule: every 15 minutes for the first hour, every 30 minutes for the second hour, then hourly. Fundus, lochia, bladder, perineum and vital signs each time.