Which of the following movements occur after delivery of the head during the mechanism of labour?

Appeared in: DSSSB -28 August 2019 (Shift-2)

Explanation

Restitution is the first cardinal movement that occurs immediately after the delivery of the fetal head.
It is a passive, spontaneous rotation of the head by about 45 degrees (one-eighth of a circle).
This movement corrects the torsion (twist) in the fetal neck that was created during internal rotation.
Restitution realigns the fetal head with its back and shoulders, preparing for the delivery of the shoulders.

Option A: Crowning occurs just before the head is delivered. It is the stage when the largest diameter of the fetal head is visible at the vaginal opening and no longer slips back between contractions.
Option B: Internal rotation happens well before the head is delivered. It is the rotation of the fetal head inside the maternal pelvis to align its longest diameter with the longest diameter of the pelvic outlet.
Option C: Flexion is one of the earliest movements in the mechanism of labor. The fetal head flexes, bringing the chin to the chest, to present the smallest possible diameter (suboccipitobregmatic) to the pelvis.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Cardinal movements in the mechanism of labor as background academic context rather than a clinical decision trigger.
Observing the cardinal movements, particularly restitution, is a key nursing assessment during delivery. It confirms that the labor is progressing normally and helps anticipate the delivery of the shoulders.
The absence of restitution after head delivery is a critical warning sign for shoulder dystocia, where the anterior shoulder is impacted behind the pubic symphysis. This requires immediate intervention.
Immediately after the head is delivered and before restitution, the nurse or birth attendant should gently check for a nuchal cord (umbilical cord wrapped around the neck).

How to Approach the Question

This is a factual recall question testing knowledge of a specific sequence of events.
Identify the key time frame in the question stem: 'after delivery of the head'.
Mentally recite or visualize the cardinal movements of labor in their correct order: Engagement -> Descent -> Flexion -> Internal Rotation -> Extension (head delivery) -> Restitution -> External Rotation -> Expulsion.
Evaluate each option against this sequence.
Eliminate 'Flexion', 'Internal Rotation', and 'Crowning' as they all occur before the head is delivered.
Identify 'Restitution' as the movement that immediately follows the delivery of the head.

Concept Tested & Keywords

QM6UoXOTq2_8jmlWSbnB0h

E6 Obstetrics Williams p. 21-39

Practise the full DSSSB -28 August 2019 (Shift-2)

Attempt every question from this paper in a timed mock, then review the full solution for each one.