Vaginal examinations aren’t the only way to tell how your labour is progressing

Posted in Birth.

Did you know that there is a way to tell how far a woman’s labour is progressing that doesn’t require her having her vagina examined? If you didn’t – this fun fact might just blow your mind. Aptly labelled ‘The Purple Line’, this line runs along a woman’s natal cleft (or in layman’s terms: her butt crack).

It begins at the anus, and as her labour progresses, it moves all the way up to the top – indicating full dilation. Being informed about this line and watching its movement can equip a woman and her chosen care providers with the knowledge of how things are going without having an intrusive vaginal examination.

This discovery is a revelation for all women and a fantastic tool to be mindful of – especially because vaginal examinations are not the only way to tell how labour is progressing, as well as not always being accurate.

Senior Lecturer in Midwifery, Dr Rachel Reed concurs.

She says that knowledge of the purple line is one assessment she uses to ascertain how labour is going for the women under her care and emphasises the importance of observing the whole woman – not just her cervix.

“Based on understanding the physiology of birth and knowing and understanding the individual woman. During labour, I am observing the pattern of labour and the woman’s behaviours … I expect a shift or a change over time. Being a midwife is an embodied experience of ‘being with’ the woman – she ‘tells’ you about progress through the way her body moves, acts, sounds and her contraction pattern,” says Dr Reed.

What research says about the purple line

In a longitudinal study performed in 2010 by Shepherd et al. on the accuracy of the purple line in labouring women, out of the 144 women observed 76 percent of them were noted to have the purple line. This means that 109 women were shown to have a physical indicator of labour’s progression through an external observation alone. The study concluded that alongside other measures, the purple line proved as a useful guide for clinicians to assess labour. 

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What research says about vaginal examinations and their efficacy

Recommendations from Queensland Health’s parent information pamphlet on vaginal examinations state that only every four hours is necessary.

As the pamphlet explains: “Vaginal examinations are the most common method of assessing progress in labour; however, they are not the only indicator. There are other factors such as the strength, duration and length of fractions as well as woman’s behaviour and wellbeing that can indicate progress in labour. While a vaginal examination can provide information about how a woman has progressed so far in labour, it cannot predict how much longer you will be in labour or when you will give birth.”

Other side effects of vaginal examinations relate to their incredibly intrusive and often painful nature. There is even evidence to suggest that the vaginal examination in itself can have a negative effect on the labouring woman, interrupting her focus and causing anxiety.

With all of this information in mind, women are encouraged to educate themselves and their care providers of the purple line and not rely solely on cervical dilation as a means of discerning labour’s progression. After all, a woman is more than just her cervix!


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