The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

By Mindy Cockeram, LCCE

Today’s blog post is a repost of one of the most popular posts ever shared on our blog. It is written by Mindy Cockeram, LCCE.  Mindy explores the “mystical” red/purple line that has been observed to provide information about cervical dilation without the need for a vaginal exam. Have you seen such a line.  Do you have other ways of identifying dilation that do not involve cervical exams?  Please share in the comments- Sharon Muza, Science & Sensibility Community Manager.

When couples in my classes are learning techniques for coping in labor, such as the Sacral Rub (sacrum counterpressure), Double Hip Squeeze and Bladder32 accupressure points,  I always talk about the great position the partner is in for spotting the red, purple or dark line (depending on skin color) that creeps up between the laboring woman’s buttocks and how – by ‘reading’ that line – he or she may be able to assess more accurately the woman’s cervical progress than the health care providers!  This empowering thought is often met with smiles and laughter especially when I translate ‘natal cleft’ into more recognizable words like ‘butt cleavage’.  Strangely, I’ve never had anyone in class mention having heard of this ‘thermometer’ for accessing cervical dilation by sight and I find this interesting considering the number of medical professionals that come through my classes.

Photo CC
http://www.flickr.com/photos/alexyra/214829536/

I first came across this body of research as an Antenatal Student Teacher with the National Childbirth Trust in London.  The article I was reading was in Practising Midwife and was a ‘look back’ at the original article (Hobbs, 1998) published in the same magazine.  The original Practising Midwife article was based on a letter referencing a small study by Byrne DL & Edmonds DK published in The Lancet in 1990.

In the 1990 letter to The Lancet, Byrne and Edmonds outlined and graphed 102 observations from eighteen midwifes on 48 laboring women. It states “The red line was seen on 91 (89%) occasions, and was completely absent in five (10.4%) women and initially absent in three (6.25%).”  The report then goes on to talk about the “significant correlation between the station of the fetal head and the red line length.”  Later the authors write: “To our knowledge, this is the first report of this red line.  We believe that it represents a clinical sign which is easy to recognize and which may offer valuable information in obstetric management.”

So how does this line work?  And why does this it appear?  Practising Midwife Magazine presented a graphic which I have attempted to recreate here.  Basically as the baby descends, a red/purplish (or perhaps brown depending on skin color) line creeps up from the anus to the top of the natal cleft in between the bottom cheeks.  When the line reaches the top of the natal cleft, 2nd stage is probably a matter of minutes away.  A line sitting an inch below the natal cleft is probably in transition.  A line just above the anus probably signifies early labor.

Byrne DL & Edmonds DK, the authors of the original study, surmise that the cause of the line is “vasocongestion at the base of the sacrum.” Furthermore, the authors reason that “this congestion possibly occurs because of increasing intrapelvic pressure as the fetal head descends, which would account for the correlation between station of the fetal head and red line length.”  Fascinating and logical!

Interestingly, I came across a 2nd Scottish study from 2010 published by BMC Pregnancy & Childbirth: (Shepherd A, Cheyne H, Kennedy S, McIntosh C, Styles M & Niven C) which aimed to assess the  percentage of women in which a line appeared (76%. ) The study cited only 48-56% accuracy of vaginal examinations to determine cervix diameter and fetal station.  So why aren’t clinicians using this less invasive visual measure – especially considering how much some women may dread vaginal exams in labor??  Wouldn’t the thought of using a methodology to lower infection rate after rupture of membranes has occurred enthuse Health Care Providers instead of using higher risk techniques?  Or how about using the accuracy of the line at the natal cleft to know when a women using epidural should really be coached to push?

My educated guess is that this information has not yet reached Medical Textbooks and non-standard practices can take years to become mainstream (for example. delayed cord clamping) – and then only if or when women request them or media sensation activates them.  In addition, since laboring women are only intermittently attended by Labor & Delivery staff during early and active labor and often encouraged to “stay in bed,” Health Care Providers aren’t necessarily faced with a woman’s buttocks in labor.  Also vaginal examinations are considered “accurate” so staff have no need to peek between a woman’s natal cleft.   However both these studies, paired with the roughly 50% accuracy rate of manual vaginal exams, show that there is potentially a more accurate and less invasive way ahead.

In The Practising Midwife (Jan 2007, Vol 10 no 1, pg 27), Lesley Hobbs writes “Accurate reading would seem to the key to this practice.  I sometimes notice in myself a wish to see the line progressing more quickly than it actually does; when I do this – and check with a vaginal exam – only to find the line is right, I get annoyed with myself and wish I’d trusted my observations.”  Later she goes on to say “I can now envisage a time when I shall feel confident enough to use this as my formal measurement mechanism and abandon intrusive and superfluous vaginal exams.”

Licensed Midwife Karen Baker from Yucaipa, CA commented “The purple line is a curious thing.  It’s definitely not present on everybody but is more prominent on some than others – especially right before pushing.  It tells us when she’s in full swing if we are in a good position to spot it!”

I often urge couples to send me a picture of the so called ‘purple line’ which I promise I will use only for educational purposes but so far a picture is as elusive as the Loch Ness Monster.  So, as I say in class, ‘show me your purple line’!

Are you a midwife, doctor, nurse or doula who has observed this in a client or patient? Partners, have you seen this when your partner was in labor? Has anyone heard of it or witnessed it?  If you are a childbirth educator, do you feel this is something that you might mention in your classes?  Do you think that the families in your classes might be likely to ask for this type of assessment if they knew about it? Please comment and share your experiences.

References

Byrne DL, Edmonds DK. 1990, Clinical method for evaluating progress in first stage labour.Lancet. 1990 Jan 13;335(8681):122.

Downe S, Gyte GML, Dahlen HG, Singata M. Routine vaginal examinations for assessing progress of labour to improve outcomes for women and babies at term (Protocol). Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD010088. DOI: 10.1002/14651858.CD010088.

Hobbs 1998. Assessing cervical dilatation without Vaginal Exams. Watching the purple line. The Practising Midwife 1(11):34-5.

About Mindy Cockeram

Mindy Cockeram is a Lamaze Certified Childbirth Educator teaching for a large network of hospitals in Southern California.  She has a BA in Communications from Villanova University and qualified as an Antenatal Teacher through the United Kingdom’s National Childbirth Trust (NCT) in 2006.  A native of the Philadelphia area, she spent 20 years in London before relocating to Redlands, CA in 2010.

91 Comments

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 9, 2012 07:00 AM by Adriana Lozada
This is incredibly interesting! I will present it to clients as another possible tool in our arsenal. I'm curious to see it. Thanks so much for sharing this information!

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 9, 2012 07:00 AM by Cheryl
I've seen it and it is an observation that contributes to my assessment of labor progress. As one observation, in combination with many others...it's not always there. I would add knowing the number I centimeters a woman is dilated is less important than her effacement which indicates the degree to which the uterus has migrated muscle cells upward toward the fundus. Mother's behavior and coping are much more telling of her progress in labor. Second stage tells US when it has arrived.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 9, 2012 07:00 AM by Emily, Anthro Doula
I first heard of the "bottom line" or "purple line" from this blog: http://sarahvine.wordpress.com/2010/03/07/how-dilated-am-i-assessing-dilation-without-an-internal-exam/ I tried to assess a mom's labor at one of my first ever births this way, but I had no idea if there was truly a line or if it was just the way her natal cleft, as you call it, always looked. Also, I wasn't sure how high it should be or what the length really meant! Thank you for the informative post, I will try to talk to parents about this and maybe we can try it again in the future :)

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 9, 2012 07:00 AM by Walker Karraa
I appreciate the work here, thank you. I would like to offer that when photos showing woman's body parts without her face, are classical patriarchal objectification--even when the intent is empowerment. We have to carefully choose the images we represent ourselves with, because those looking back are searching for reflections of their whole self, their complete embodiment of childbirth--not merely a part of the body that identifies it. You know?

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 9, 2012 07:00 AM by Shanon
I was just at a birth last week. I had been with this couple before and knew she was moments away from pushing when she got on her hands and knees on the bed in front of me and I thought "aha! the purple line!" It was so prominent, it was like the color of a rope burn and she began to push in the next contraction.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 9, 2012 07:00 AM by Jenn
Hello. I am a nurse-midwife, and just had my first baby 5 weeks ago. I had a lovely home birth, and spent some time on hands and knees in second stage. My midwives, doula and partner all commented on my deep purple line as I was pushing. I have seen this a few times on women in labor (despite having worked in a setting with a very unfortunately high epidural rate of >85%). I was thrilled to know I had one! What I did not know prior to this article was that the length of the line was indicative of labor progress. I thought it was simply a phenomenon of active labor. Interesting! When I resume practice after my mat leave (at a new job in birth center and home settings! Yay!), I will take note of this more often. Thanks!

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 9, 2012 07:00 AM by Mary
I have heard of this line and also have seen it in women in labour in my work as a doula. As a result I tell couples about it in my GentleBirth workshops and send them a link to another article about it - I can send them on this article now as well. Thank you!

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 10, 2012 07:00 AM by Andrea Steinlechner
I am very intrigued by this. I assume is what in Chinese Medicine we call the “conception vessel”. Will have to look it next time I attend a birth. Thank you for sharing.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 10, 2012 07:00 AM by Cathi
@Jenn Congrats on your new baby, and I am so glad you had a Homebirth! It will change your practice I promise! Enjoy your baby moon!

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 10, 2012 07:00 AM by Cathi
@Jenn Congrats on your new baby, and I am so glad you had a Homebirth! It will change your practice I promise! Enjoy your baby moon!

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 10, 2012 07:00 AM by sara maimon
I have hemmhorroids, would that obscure the line?

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 10, 2012 07:00 AM by wendy
I had the purple line and a photo to prove it :) I also refused all VE's and my midwife was very respectful of my wishes and was happy to observe me to see if I was in established labour before I got in the pool. She was amazing! :)

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 10, 2012 07:00 AM by Mindy A. Cockeram, LCCE
@Walker Karraa Hi Walker, thanks for your comment. Perhaps we could have a conversation offline (mindy@cockeram.com) b/c I'm not clear on your point and want to understand what you mean. Many Thanks, Mindy

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 10, 2012 07:00 AM by Linda J. Middlekauff, RN, BSN, LCCE
Thank you, Mindy, for this great info! I'm a nurse LCCE, & although I'd never heard of the red-purple line as a way to determine labor progress, I've been telling my students to never rely on dilation as a measure of progress in labor. Rather, I tell them to observe the physical & emotional changes the mother presents which are not only more reliable but also keep the mom & her partner from getting so discouraged to be say only 4 cms for several hours, seemingly making no progress if based on dilation alone. They're less likely to request or give in to the pressure to have an epidural when they know they ARE making progress. I also think that effacement is a better indicator of progress than dilation, but I'm looking forward to teaching about the natal line. Some of my students are more interested in non-invasive apporaches, so this is a potentially great tool for them. I look forward to reading more about this method. What a great study this would make for someone's PhD!

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 10, 2012 07:00 AM by Kirsten
Is it possible that the red-purple line would show up better using different types of light, such as the UV lights used to visualize trace evidence? Maybe dimming the lights and using a UV or IR flashlight would help it come out of hiding.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 11, 2012 07:00 AM by Regine Marton CNM
I confirtm this fact, ang its use in my practice,,, Since I live in Brasil it is sometimes difficult to see it by darker skins... It is a well known tool amongst Mayan Midwives of central America. Thanks for providing the references ... and more evidence.. Regine Marton CNM Natal RN Brazil

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 11, 2012 07:00 AM by Science & Sensibility » The Red/Purple Line: An Alternate Method For Assessing Cervical Dil
[...] Science & Sensibility » The Red/Purple Line: An Alternate Method For Assessing Cervical Dilatio.... [...]

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 11, 2012 07:00 AM by Violet Persuasion
:) There is actually a picture of one here: http://wonderfullymadebelliesandbabies.blogspot.com/2011/07/dilation-how-to-check-without-checking.html

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 14, 2012 07:00 AM by Mindy A. Cockeram, LCCE
@Kirsten Possibly!

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 16, 2012 07:00 AM by Rachael
My midwife said two years ago that I am the first woman that she observed 'the line' on. New baby due in six weeks. Not sure if I'm brave enough to have someone take a picture though...

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 16, 2012 07:00 AM by sarah
i am not sure how to word this correctly, so hopefully i dont cause confusion; is the line just between the butt cheeks covering the coccyx or does it cover part of the cheeks within the crack itself!? like, is the line pencil thin, or does it look like a basting brush width between the cheeks? i recently observed a brownish line in the crack of a mom, it was from the anus to the top of the crack and her baby was out within 5 min of noticing it, i wasnt aware of this sign then, so i just assumed that it was the color of her butt crack as she has darker skin. it was the entire crack, like a basting brush had been run between the cheeks, not just a thin line over the coccyx. sorry for the redundancies, just trying to be as clear as possible.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 16, 2012 07:00 AM by Judy Machorek, LCCE,CD
Your point is well taken. @Walker Karraa

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 16, 2012 07:00 AM by Sharon Muza, BS, LCCE, FACCE, CD(DONA), BDT(DONA)
@sarah I think it is darkest on the line between the cheeks, but it can have some width to it, getting lighter, as it moves away from the "crack" onto the cheeks...at least, the ones I have been able to observe. Hope this helps.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 16, 2012 07:00 AM by Meliea
Great post. I sent you a picture!

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 16, 2012 07:00 AM by RK
I have a picture that shows it (baby's head is born and rotating for the rest of baby to be born), what email address should it be sent to?

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 16, 2012 07:00 AM by Sharon Muza, BS, LCCE, FACCE, CD(DONA), BDT(DONA)
@RK Who are you addressing? I can be reached through the blog, if you wish to send me something.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 16, 2012 07:00 AM by The Red/Purple Line- Alternative For Assessing Cervical Dilation | Woven & Spun Birth Doula
[...] Got this article from Science & Sensibility [...]

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 16, 2012 07:00 AM by Christy
Yes, and with a great photo to boot:)

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 16, 2012 07:00 AM by Angela
as a traditional midwife for 30+ yrs I have learned the non intrusive ways to find how a Mom is progressing and one of them is the red/purple or brownish line between the "butt" cheeks. I am sorry that I do not remember how I came to know this but have been using it for many years especially when I am a doula- It is cool to see how accurate it can be when the position of the line matches the VE. I think it would be good to use this method before routine VE's. We can learn a lot from the Art of midwifery. Just being "with women".

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 16, 2012 07:00 AM by Lisa
I have seen this as well and really feel it is accurate. I prefer to assess based on mother's behavior but it is very interesting to my scientific mind so I watch for it when I can! And as was said, not every woman exhibits it and I rarely mention it except to my partner midwife or assistant. I think it would be a wonderful thing to share with attendants of CBE classes if I was teaching them.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 18, 2012 07:00 AM by Carolyn
Another fascinating piece of information that I can archive. I've passed the link for this onto our Access Group Facebook page for all aspiring midwives. (It also helps that we are being encouraged to reference our findings in journals and on-line so this is very topical right now) thank you.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 18, 2012 07:00 AM by Tanya Strusberg, LCCE, FACCE
Absolutely fascinating information! Thank you so much for sharing! I have never come across this until today! I think it will make for a very animated discussion point in my Lamaze courses!

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 19, 2012 07:00 AM by caroline walker
Observe it all the time in our practice.I use it as a clear sign of progress and tell our clients about it.the more you observe the more accurate you get.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 20, 2012 07:00 AM by Karen J. Kennedy, LCCE
@Walker Karraa I completely agree - though I'd like to know 1) how you can get a good picture of a laboring woman's crack *and* her face, and 2) what woman would allow such a picture of herself to be used online. In a case such as this, how is it disempowering to show the specific physical phenomenon under discussion? Especially if the woman has consented to having her butt crack picture used to help other women avoid invasive VEs?

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 21, 2012 07:00 AM by Sunday News Round-Up, Got Distracted So I’m Still at Level 89 Edition « Women's Hea
[...] The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues I’d never heard of or seen this before, you? Would love to hear from some of the various types of birth attendants in the readership. [...]

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 22, 2012 07:00 AM by Agnes Gereb
Dear Sharon, I am an independent midwife in Hungary (at the moment in house arrest). We with my midwife fellows know and use this red-purple line. But I generally can observe it only from 4-5 centimeters.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 22, 2012 07:00 AM by Jordan McCormack
Here's mine. This was the pushing phase with my first baby. My mom mentioned the line to my sisters while I was labouring. She knew about it, as a retired midwife's assistant. She's seen it many times.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 26, 2012 07:00 AM by Jenna Monro-Argent
Hello Sharon, I am a student midwife and the 'purple line' is acknowleged in one of our text books 'Midwife's labour and birth handbook' (2009) Chapman & Charles. Though it is not extensively discussed. I will be keenly observing this method of estimating dilation!

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 26, 2012 07:00 AM by Monica
I see this in women all the time. It is a great Non invasive sign. It is not present all the time but when it is I believe it is quite accurate. If used with what women are also telling us or the noises she makes then it is amazing. I also look at the " bulge" in the sacral area to assess head descent :-)

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 27, 2012 07:00 AM by Libby Gregg
I am a midwife and have seen and used the purple line as an assessment tool. However it is not present in all women, in my experience most women don't demonstrate it. Further a VE is the only way of being certain of the position and flexion of the head. This detail is as important as dilation in assessing the process of labour and so it is not good practice to replace a necessary VE with observation of the line.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

November 20, 2012 07:00 AM by Assessing dilation without internal
[...] To find out why, and more about assessing your labour through the red/purple line see the full article. [...]

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

December 13, 2012 07:00 AM by Carla Hartley
I first learned about the Hobbs line (though it was not called that) from an elderly granny midwife in the late 70s. I think women may have been observing this for a really long time.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

December 29, 2012 07:00 AM by Lori Vick
Has anyone ever seen the purple line in someone not in active labour? I'm 40 weeks +1 day - had a VE over a week ago and was 3 cm and 75% effaced. Learned abut the purple line today and had a look. It's very obviously there and right to the top but I'm not in labour. Baby is sunny side up - could that cause it? thanks

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

December 31, 2012 07:00 AM by Say no to cervical checks! « Lotus Midwifery • Rowen Holland, LM, CPM
[...] There are alternatives to having vaginal exams in labor to check your dilation – have you heard of the red/purple line? [...]

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

January 6, 2013 07:00 AM by The Placenta Blog » Blog Archive » In Leiu of Vaginal Checks, Look For The Line!
[...] Byrne DL & Edmonds DK, the authors of the original study, surmise that the cause of the line is ‘vasocongestion at the base of the sacrum.’ Furthermore, the authors reason that ‘this congestion possibly occurs because of increasing intrapelvic pressure as the fetal head descends, which would account for the correlation between station of the fetal head and red line length.’”˙ -Science & Sensibility [...]

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

January 8, 2013 07:00 AM by Science & Sensibility ¯ The Red/Purple Line: An Alternate Method For Assessing Cervical Dil
[...] Science & Sensibility Ż The Red/Purple Line: An Alternate Method For Assessing Cervical Dilatio.... [...]

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

January 26, 2013 07:00 AM by Molly Ferguson
As a homebirth midwife, I feel I am relatively conservative w/ vaginal exams, and will definitely start observing women for this sign of progression. I usually reserve VE's for times when I want more information that can be put to practical use: as mentioned the position and flexion of the head, and evenness of dilation. I almost always use this information help moms into positions that will encourage even dilation and optimal fetal positioning. The line doesn't give me this info; that being said, many labors don't require any VE's, as the progress is monitored by mom's sounds and behavior. Its always the whole picture, and I'm glad to have a new tool.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

January 27, 2013 07:00 AM by Toshia Parker
Hello I am a doula and have noticed this many times. I have used it to assess when it might be time for us to leave for the hospital especially if mom wants to stay home as long as possible.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

January 28, 2013 07:00 AM by Billie-jean mcmanus
I am a midwife and have seen the purple several occasions with labouring women. Mostly noticed when standing and when almost fully dilated. I find this fascinating and have pointed it out to other midwives who havent heard of it. Always gets a great response

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

January 28, 2013 07:00 AM by LisaP
Hi, Im a midwife in NZ I have used this method for assessing cervical dilation for years and it is often accurate BUT I have been tricked several times when the baby is in the OP position ....

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

January 28, 2013 07:00 AM by Sharon Muza, BS, LCCE, FACCE, CD(DONA), BDT(DONA)
@lisap, why do you think that is? Are you tricked into thinking mom is further along then she is? or the reverse? Why do you think the OP baby makes it inaccurate at times? Curious. Thanks, Sharon

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

January 31, 2013 07:00 AM by This completely blows my mind « jtpoppyseeds
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The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

February 4, 2013 07:00 AM by The purple line… « Lotus Midwifery ? Rowen Holland, LM, CPM
[...] article about assessing cervical dilation in labor without vaginal exams – the purple line! Share this:TwitterFacebookLike this:LikeBe the first to like [...]

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

February 5, 2013 07:00 AM by Lucky 13 | Fluff and Puffery
[...] If I had it to do over, I would have listened to the voice in my head telling me to look for˙the purple line. I also would have called ahead and let the staff know to expect [...]

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

February 7, 2013 07:00 AM by Science & Sensibility ¯ The Red/Purple Line: An Alternate Method For Assessing Cervical Dil
[...] Science & Sensibility Ż The Red/Purple Line: An Alternate Method For Assessing Cervical Dilatio.... Share this:TwitterFacebookLike this:LikeBe the first to like this. This entry was posted in midwifery by crookedcoast. Bookmark the permalink. [...]

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

March 24, 2013 07:00 AM by Anon
So one study only demonstrates about 76% of women have this line, and it only correlates 50% with vaginal exams. Doesn't sound too reliable. Where are the pictures of this? I have a hard time understanding the 48-56% inaccuracy of vaginal exams. Are they talking about descrepancy between providers? Resident or nurse exams? If you have the same midwife or doctor performing vaginal exams, that person can accurately determine the dilation, effacement, and station and especially progress or a change from exam to exam. Labor is about making cervical change and even if someone disagrees about someone being 5 or 6 cm, if you examine them again hours later, everyone (100%) can tell if the exam is unchanged or progress has been made. If this line is physiologic related to venous congestion then I hypothesize that the longer the labor is or the longer the baby's head in in the pelvis, then the congestion there will worsen despite change in cervix or station. Just like edema is worse in the legs at the end of the day compared to mornings, pelvic venous congestion may be worse with longer labors. This could very well be a confounding factor in interpretation. A recent article from AJOG showed that the number of vaginal exams while in labor did not increase infection rate. Common sense still dictates to limits exams, but this article was reassuring.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

March 24, 2013 07:00 AM by Anon
I agree with Molly Fergeson. So many factors are taken into consideration when assessing labor. Over 21 years I have seen women arrive at the birth center or be brought to the hospital by ambulance vocalizing and ready to push, only to find them 1-2 cm. Other stoic women arrive very comfortable and are 8-9 cm along. Maternal signs can be quite variable. If the red line is only present 50-75% of the time, it won't be reliable for every delivery. If venous congestion is thought to be why the red line occurs, then length of labor, time spent of the fetal head in the pelvis, presence of hemorrhoids, hyper pigmentation of the anus will all be confounding factors. Most labors don't need many cervical exams. So one can be performed if clinical judgement dictates one. Initial exam can confirm presentation so no surprise breeches are starting in labor. Especially with moms with larger BMI, when Leopold's exam may be less obvious. All three factors (dilatation, effacement, and station) are important in judging progress. I like to see descent of station. Any baby that remains high worries me about larger babies and SD risk. For those that say effacement is more important than dilatation, do you really feel a fully effaced cervix at 1cm is better than someone complete and 50% effaced? And if the head is high, that is worse. Whether this is the women's first pregnancy or fifth will determine importance of dilatation and effacement. As first time moms usually efface first than dilate and multips tend to dilate as they efface. Cervical exams can help determine position and asynclitism which helps me put the patient into positions to help move the baby into optimal position for birth. Cervical progress can really only be assessed best by examining the cervix. We don't assess other body changes (weight, height, BP, heart, kidney infection, pneumonia, stroke, DVT, ) without examining the organ in question. Why not check the cervix?

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

June 21, 2013 07:00 AM by Stacie L.
I am a doula, and I was lucky enough to see and utilize this knowledge during my last client birth! It was very cool to see. We guessed that mom was about 7cm or so and she was ready to go to the birth center. When we got there her midwife checked her and said she was almost an 8, but we'd say a 7, just to give her more time. How awesome!!

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

July 1, 2013 07:00 AM by Melissa Frock
I have a great picture. Where should I send it?

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

July 1, 2013 07:00 AM by Sharon Muza, BS, LCCE, FACCE, CD(DONA), BDT(DONA)
you can upload it someplace and link in the comments? will that work?

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

July 11, 2013 07:00 AM by Anesha
i'm 30 weeks pregnant with my fifth and came across the purple line information. So i looked if i could see a line and i didnt have one. i know i'm 1 cm dialated. So a couple of days later i checked again and i have a very darkred line all the way up to the top of my crack, i know i'm still 1 cm dialated. So what does this mean?

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

July 20, 2013 07:00 AM by Georgia Mom
I am 36 weeks pregnant with twins. My last cervical check, at 32 weeks, I was 2cm dilated, 25% effaced, and Baby A was very low. I just checked my "natal cleft" and there is a very clear reddish-purple line nearly all the way up it--high enough to suggest I might be 8 or 9 cm at the moment (which I rather doubt). I wonder if the increased pressure of twin pregnancies makes it more likely for the line to appear--and to appear higher--earlier? It's all very interesting, in any case, and certainly more studies should be done on it.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

July 28, 2013 07:00 AM by Red line on butt crack = dilation? - BabyandBump
[...] before in some birth stories that midwives use this line to tell if you're dilated and googled it: http://www.scienceandsensibility.org/?p=5547 Anyone else have this? I am pretty sure I'm not fully dilated, lol, but the red line goes all the [...]

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

September 4, 2013 07:00 AM by Question Everything (and don’t trust anyone over 35 to have a baby?) | Six Forty Nine
[...] say in a nerdy whisper. Did you know that you can tell cervical changes in a woman by looking at a purple line on her back?˙Alas, just like when you start promoting the (well-known) fact that Han shot first, there comes a [...]

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

September 15, 2013 07:00 AM by Mindy A. Cockeram, LCCE
@Georgia Mom Interesting! I now wonder too (about twins) and agree more studies should be done. Best of luck and sorry for the delay in replying. Suspect you have your hands full by now.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

September 17, 2013 07:00 AM by Start Here If You Are Pregnant | Six Forty Nine
[...] Random facts about holistic laboring: Here. [...]

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

October 25, 2013 07:00 AM by Rebecca
At my last check up I was 3cm dilated,90% effaced and baby's station is -1. I told my midwife that I had noticed the purple line which she asked to see. My line was almost exactly where it is in your picture. A reddish/pink line extends all the way up, but the purple line was just slightly up. I wonder if some people are mistaking the lighter line with the actual line which is much darker.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

January 26, 2014 07:00 AM by The Mystical Purple Line | The Birthing Room
[…] http://www.scienceandsensibility.org/?p=5547#.UZ-SkhGX55M.facebook […]

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

February 23, 2014 07:00 AM by Melanie (doula)
Yes, I have seen the purple line in a client. It was all the way up the natal cleft when she was in second stage labor (pushing). Right on!

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

April 17, 2014 07:00 AM by Sofia
i wonder if the line shows even if the baby is high. In both pregnancies my babies were high and I've been wondering of that line has something to do with baby's position. Maybe the woman that doesn't show it have high babies so there isn't pressure to produce the line? perhaps it has to do with dilation and descend?

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

July 4, 2014 07:00 AM by Shannon Wade
Wow! I will certainly bring this to the attention of my clients and see if I can start my own research!

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

July 4, 2014 07:00 AM by Sara Ann Glatz, LCCE
This was incredibly helpful. As a certified Birth Doula I encounter many women who complain that they hated the vaginal exams during labor and wished there was another way to tell how far along their labor was without the invasive procedure. The red/purple line might be the solution to this. Many of the women I support through labor are already in the hands and knees position when they are nearing the end of transition. It would be an easy position to check the line and also means the mother does not have to move for the typical vaginal exam done at that point. I do hope word of the red/purple line gains publicity and popularity. I teach Childbirth Education and intend on mentioning it in my classes. If enough women start asking about it when they are in labor, maybe we will start a new trend in our hospital.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

July 10, 2014 07:00 AM by Doris
I just re-read the birth notes from my doula from the birth of my second child which took place in the birthing center of a hospital. She states ".. I and the midwife were sure you were fully dilated or very close. You were now spontaneously pushing through the peak of every contraction and had an ever brightening purple line running up from the top of your bottom - a sign of full dilation".. Well I never saw this myself, my baby was OP and I was a bit stressed out by then and past frustration. But they were right and the baby was finally born shortly afterwards. We're based in London. If my husband would have taken photos I would probably have ... him.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

August 12, 2014 07:00 AM by Sarah
Wow! This is interesting! I'm currently pregnant with my 3rd baby and have NEVER heard of this even though I've done extensive research on holistic pregnancy and birth and opted for a holistic birth center for my last child (and this one). Does Ina May Gaskin mention this in her research at all? I've read a lot of her work but don't remember this. If I had a line, the midwife and nurses would definitely have been able to see it last time since I was on the bed leaned over a birthing ball most of the time. This would have been helpful knowledge before I went to the birthing center last time since I didn't know how progressed I was (I went in at 8 cm) and told my husband to leave everything in the car just in case they said to go back home :)

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

August 18, 2014 07:00 AM by Virginia
I often watch this purple line with clients in labour. A wonderful tool.

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

August 19, 2014 07:00 AM by nico
My fiancée is pregnant with our first kid. I'm very interested in this whole pregnancy. I've done the vaginal exam myself on her. We went into the hospital because we thought her water broke, she was 5cm they didn't keep her because she isn't experiencing labor pains, she had high pain tolerance. When we got home I was looking up other ways to check dilation and ran across some articles talking about this purple line. We tested it out that day sure enough it read 5 cm. So we've been doing it everyday and she almost measures 7 cm now but again she isn't feeling the pain they want her too feel. So we sadly wait for the due date...which is only 2 weeks away!!! (September 3rd) Medical professionals should jump on this and see how accurate it is compared and make it more known. NO one we've mentioned it too has ever heard of it!

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

August 24, 2014 07:00 AM by breena
@Virginia I have just learned about this purple line, and i am with my third child. Earlier this weekend I had a internal exam that said i was at 2cm, so I checked and found that yes I have this line, but I am very confused as to how to understand the length of the purple line to the the dilation of the cervix{example I am 2cm does that mean the line should be only 2cm?}

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

December 2, 2014 07:00 AM by Dee
I currently have a red line that would suggest 7-8 cm, but I have no dilation from what I have been told and are 38 weeks pregnant, just notice the line tonight..Interesting

I am a Lamaze certified child

January 4, 2015 07:00 AM by Erin Greene- Rettig
I am a Lamaze certified child birth educator I teach this in my class and send them to this website for more information I as a Doula have used this and it is amazing how well it works not all moms have it but those who do it has been Spot on!

Im a nurse, and though I did n

January 5, 2015 07:00 AM by Breanna Jewell
Im a nurse, and though I did not learn about the purple line in my education, I did hear about it while researching natural childbirth during my pregnancy. In labor with my second baby, I was preparing to get in the shower after crazy inconsistent labor, and when I glanced in the mirror I saw the line!!! I ran out of the bathroom and showed my husband, and my friend came over and I showed her too. It was awesome! I could feel baby low in my pelvis, like a baseball between my legs, so I knew she was coming soon. Unfortunately I didn't get a picture. But it was definently there!!!

Thank you so much for this gre

February 24, 2015 07:00 AM by Elen Capucine
Thank you so much for this great informations! I am a midwife student actually writing an essay about the use of vaginal examination during labour and it's alternatives so your article really helps. As a way to improve my research I am wondering if you could send me the article you're citing: Hobbs 1998. Assessing cervical dilatation without Vaginal Exams. Watching the purple line. The Practising Midwife 1(11):34-5, I have been looking everywhere for it and did not find it. Thanks in advence. Elen Capucine

I am in labour, about 5.5cm di

February 26, 2015 07:00 AM by connie
I am in labour, about 5.5cm dilated. Asked my husband to check my reddish line and it is just over half way up between my anus and the end of my "crack". Before telling my husband how dilated I am, he said "if true, you must be about 6cms dilated"!!

Maybe mine is the wrong shade

February 26, 2015 07:00 AM by Uriah Suskey
Maybe mine is the wrong shade of purple. If I had a way, I'd send you a picture and I'd love to hear what you have to say!

Hello, my name is Uriah. I am

February 26, 2015 07:00 AM by Uriah Suskey
Hello, my name is Uriah. I am 34 weeks pregnant. I have the purple line and called a nurse. She's unaware of the study. I live an hour away from my chosen OB. I've heard of it for a while now. I'll keep doing research. I've had 2 kids and I've never dilated on my own before. Seeing that line leaves me with excitement! Maybe this will be a normal labor. I hope its accurate! Since I was 30 weeks I've began to have Braxton hicks contractions. They are small but noticeable because I lose my breath. I also feel how low my son is and there are times when I just want to drop. Also he pushes down so hard I feel like he's going to tear me. Anyways, when I spoke to one of my nurses, I had just got out of a warm/hot bath and she said that may be why the line is there. Who knows! I guess I'll find out in two weeks.

I had a home birth client 3.5

May 28, 2015 07:00 AM by Dee G
I had a home birth client 3.5 hrs away from me. We used the purple line to detect progress. It was accurate in determining that she WAS progressing, but the lines did not match up to the progress exactly (i.e. she showed 8cm dilation when I arrived she was 6 cm)

So the line I have my husband

September 13, 2015 07:00 AM by jerri
So the line I have my husband says reaches the top of my bottem but I am only 35 weeks I feel lots of pressure down there so what do recommend I do at this point

Do you still need a picture? B

October 2, 2015 07:00 AM by Angelica
Do you still need a picture? Because I have an INCREDIBLE one from my water birth. Shoot me an email if you're interested. Happy to share!

As a doula I have seen this ma

October 4, 2015 07:00 AM by Heidi K.
As a doula I have seen this many times and it's been accurate every time. I mentioned it to a nurse onc and she looked at me like I was crazy, lol.

Yes! And I have a photo! I am

November 17, 2015 07:00 AM by Kate
Yes! And I have a photo! I am a photographer and captured the red line during a water-homebirth!

I still have the purple line f

December 7, 2015 07:00 AM by Natasha
I still have the purple line from my bum hole to the bottom of my spine but I'm not longer pregnant I had a baby 17 months ago but I thought it would have gone by now, does anyone know why I have it and how I can get rid of it??

As a labor and delivery nurse,

February 24, 2016 07:00 AM by Rachel RN-C, BSN
As a labor and delivery nurse, I have observed that sometime the station of the head can be very low without being dilated more then 2 cm. it sis fairly common to be -2 station and closed. A woman can be very posterior and dilated. I have located the head fairly low, but the cervix can be way up and back around the other side. That may be why they are not always accurate.

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