Which is the correct sequence of the fetal head movements during birth from rotation to rotation?

• A. Internal rotation, Extension, Restitution, External rotation
• B. External rotation, Restitution, Extension, Internal rotation
• C. Internal rotation, Restitution, Extension, External rotation
• D. Internal rotation, Extension, Restitution, External rotation

Answer: (D)

The main idea is the order of how the fetal head moves as it passes through the birth canal—the mechanism of labor. After descent and engagement, the head first experiences internal rotation to align with the maternal pelvic planes, typically turning so the occiput faces anterior. Then the head extends as it moves under the pubic symphysis to navigate the outlet. Once the head is born, it undergoes restitution, turning to realign with the shoulders as the neck untwists. Finally, external rotation occurs as the shoulders rotate within the pelvis and the head pivots to a position that allows the rest of the body to be born. This sequence—internal rotation, extension, restitution, external rotation—is why that option is correct.