The pelvic floor and uterine contractions work together to produce this cardinal movement just before the fetal head is delivered. The "a couple of force" hypothesis is extended in order to deliver the head. At this point, the vulval outlet is stretched to its maximum diameter without any head recession even after the contraction is finished, a process known as crowing of the head. The largest part of the pelvic floor that the fetus can pass through is here.Īfter internal head rotation, the sub occiput continues to descend until it is below the public arch. The pubococcygeus and iliococcygeus muscles' anatomical arrangement will lead the occiput to be pushed to rotate toward the symphysis pubis. The fetus will be in a transverse position at the time of engagement and vertex descent into the pelvis. This will cause the flexion of the fetal head onto the thorax.
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