Most women on arriving at hospital in labour are given a vaginal examination to assess their progress and the position, station and if possible presentation of the baby.
Or, I should say, are “offered” a vaginal examination. Few women decline it; most women accept it because they don’t realise they are entitled to decline it; and most women would not decline it even if they did realise this was their right…because they are keen to know what their progress has been.
There are however other ways of knowing how far labour has progressed, less invasive and more dependent on gentle observation.
I was Doula-ing for a second-time mum recently. When we arrived at the birth centre she was coping beautifully. The wonderful midwife (Queen Charlotte’s) never gave her a vaginal exam – no need. I was rubbing the mum’s back, the midwife was filling the birth pool, the mum was breathing and moving beautifully through her surges. If I remember to I try to look out for the ‘purple line’ in these circumstances. It is a vertical dark line that gradually extends north between the buttocks. I have seen it once before but wasn’t sure then as I didn’t know if it had just appeared or maybe was something the mum had normally.
On this occasion it was there, clear as day. A line about a quarter of a centimetre wide starting at her anus and extending “northwards” between her buttocks in what the medical people call the “natal cleft” and you and I call the “bumcrack”. It was so clear it almost looked like a felt-tip pen mark in purplish-red!
Unfortunately I didn’t whip out my phone and take a photo…we had other things to think about…but I have found there are a few, very few, photos on the web of a similar purple line. I have to say my client’s was even more marked than the one in this picture. It was more like the one here on Gloria Lemay’s blog
The wise women tell us that the line begins to appear at between 0 and 2cm dilation of the cervix and lengthens as labour progresses, but not necessarily steadily. When it reaches the “nape” of the buttocks – that’s the point where for most people the coccyx begins to curve inwards, then the woman’s cervix is very likely fully dilated.
What exactly IS this purple line?
“The reason for the Purple Line is believed to be due to the increased pressure on the veins around the sacrum. This pressure on the veins creates the dark line where the thin skin of the cleft can show it. This pressure from the head creating the line also means that you can reasonably assess the station of the baby’s head as it moves down. Lower head = more pressure = higher line.” – birthwithoutfearblog.com
The purple line is only one sign of advancing labour and it’s only visible in light-skinned women. Most of the time we try to judge a woman’s progress by her behaviour.
Up to about six centimetres she can talk between her surges; she might be grumbling a fair amount but she is basically still engaging with her surroundings. After this point she may become increasingly “into herself”. If she’s coping well she will be focussing on each surge, concentrating on her breathing and rhythmical movements such as hip swinging, circling on the birthing ball, swaying from side to side. She may begin to vocalise during each surge as well, and if she can keep the sound as far down the scale as possible – a nice low MOOOO sound for example as opposed to a high pitched EEEEK sound – she will be coping better. She won’t want anyone talking to her – she is “on anozzer planet” as Dr Michel Odent used to say in his inexplicably thick French accent when I was doing his doula training course. She’s in “labourland”.
Round about 8-10 centimetres things often seem overwhelming. Some women become snappy and angry, others afraid. The body releases a jolt of adrenaline towards the end of first stage labour – it’s as though the body knows there’s a bit of hard work up ahead and gives itself a double espresso to stay alert. With the adrenaline come a cocktail of emotions: fear, anger, wanting to run away – all very normal. This is the stage when a woman who has been coping well may feel she can’t do it, she wants an epidural, she just can’t go on any more.
If you are planning a hospital birth, talk with your partner about these phases. With a normal labour with no other complications it’s idea for the mum to arrive at hospital and find she’s already four or more centimetres dilated otherwise she is not judged to be in “active” labour and she’ ll be sent home…or to the antenatal ward…nobody wants that. So have a think about the difference between early labour – when the woman is still engaging with her surroundings – and the middle bit when she is withdrawing “into herself”. And, especially (but not exclusively) if she’s light-skinned, watch out for the purple line!