Through several years of being a part of the birth world I have noticed a trend. Dilation is *the* birth topic. No matter how a mother plans to birth, when the time draws near, dilation is the one thing on her mind. Why? Cervical dilation tells us one thing and one thing only – where you are right that second. It tells you nothing about what came before that check (when you compare to other labors or women) and it tells you nothing about what is to come. It only tells you about the here and now.
The news of little or a lot of dilation can either help or hurt a mother’s mental state in labor. If the mother has been in early labor for days (which is normal), the news of a only 1 or 2cm of “progress” can completely take her out of a peaceful state of mind. If the mother has only been in labor for a few hours and finds out she is already at say, 7cm, she may think her time is nigh…only to find out that she has many more hours of work ahead. Basically – the information can back fire on you.
But there are times when the information can be of use. For instance, a mother may plan to wait to get an epidural until “x” dilation. Or she may be waiting to call her family until she is sure things are really cooking. So what are the ways of getting this information? The first thought that comes to mind (and the only thought usually) is that you must have a vaginal exam.
Guess what? You don’t! That’s right – no one has to put their hands in your vagina to give you this information. Vaginal checks come with their own set of risks, from accidental rupture of membranes (or not so accidental – some care providers have used it as a good time to break mother’s water without asking) to increased risk of infection.
Studies also show that vaginal exams are not really accurate. When checking for exact dilation, studies show the accuracy to be around 48-56%. When allowing a margin of 1cm (which is a large margin of error when this information is used to time interventions or labor “cut-offs”) the accuracy is around 89-91%. [One such study abstract from real women in labor. And another study abstract which was done on models.] When you add in multiple people checking, the accuracy gets even worse. Yet, vaginal exams are considered the “gold standard” of assessing labor progress. And lets not forget that vaginal exams are just plain uncomfortable at the best of times – in labor they can be downright hellish.
So what are some ways of figuring out your dilation without actually touching the cervix?
The Purple Line or Bottom Line
This is a purple/dark line that shows up and extends well, to put it delicately, along your natal cleft. Or rather – your butt crack. The line starts at the anus and moves up the cleft. When it is all the way to the top, you are 10cm. Normally – you do have a bit of a line there. But this Purple Line or Bottom Line is not he line that is normally there (which is usually pink). This is a dark purple line. My suggestion is to check out your bum in early pregnancy so that you know the difference.
A study was done in 2010, and published by BMC Pregnancy & Childbirth, that proves the existence and accuracy of the purple line for many women. In this study, the line itself was present at some point in labor for 76% of women. The line was more apt to show in women with spontaneous labor than in those with induced labor (80% vs. 59%). The further dilated a woman was, the more likely she was to have the line show up. The line showed up most when women were around 7-8cm dilated, and seemed to fade in some women at almost complete dilation. And according to this study sample, the line seems to first show for most women around 3-4cm.
An earlier study was done in 1990 and published in the Lancet which also proved the existence and accuracy of the line, though the sample size was smaller. In this study, the line was seen about 89% of the time and was only completely absent in 10% of women. They noticed a significant correlation between the station of the baby’s head and the length of the 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.
Here is a great example of the Purple Line from a wonderful mother in our support group. Obviously – she is complete in this photo, and baby is on its way out! But you can see the Purple Line so clearly (though I did take the liberty of highlighting it for you). Thank you Sara for sharing this moment with us!
With the relative accuracy of this method, and especially considering the inaccuracy of vaginal checks, this is a great way for women to check themselves without “checking”. This would also be a pretty accurate way of judging when to head to the hospital (if that is your plan) if you are one of the 76% of women this line shows up for.
The photo below is from Jackie, who was so excited when her purple line showed up around 8cm she actually asked her photographer to snap a photo!
Sounds of Birth
The sounds a woman makes in labor can tell a care provider (or partner) much about where the woman is in labor. Obviously, this will not work the same for all women. Some women are noisy all the way through – which is fine. Some women are quiet until the very end – also fine and normal. However, there does seem to be a pattern for most women in the way they vocalize in labor.
In early labor (0 to 4cm) a women can normally converse easily or with little effort during contractions. She does not feel the need to rest between them very much, and will most likely continue or pick the conversation right back up after each contraction. In active labor (4 – 6 or 7 cm) the woman usually has to do some breathing or vocalizing during contractions, and normally stops speaking during them. She may have to rest more between them.
In transition (7 – 9cm) the woman tends to really need labor noises – groaning, moaning, and sometimes repetitive mantras or noises. At full dilation the women may really retreat within and become quiet. She may not want to speak at all, even between contractions. Pushing of course has its own set of noises. And just a note on noises – low and open noises seem to help women dilate. Keeping the jaw slack and not clenching helps the pelvic area to open and not clench as well.
Smell
This is something that birth workers will talk about and recognize. Just before the start of transition, the woman emits an earthy and very “birthy” smell. Musky and deep, it speaks to some inner part of our being and psyche.
Fundal Height
This is a documented way of measuring dilation externally. When not in labor and full term the fundal height is normally 5 finger-breadths between the fundus (top of the uterus) to the bottom of the breast bone. As labor progresses, the uterus pulls up on the bottom of the uterus (which is the cervical opening) and this is what creates dilation. Think of it as the uterus “bunching up” at the top in order to pull the bottom up and open.
As dilation progresses, the finger-breadths between the fundus and the breast bone becomes smaller and smaller – at full dilation, you can normally no longer find the gap between the two. This measurement must be done at the height of the contraction, and while mother is on her back. This means it will not be the most comfortable way of assessing progress – but it does work.
Emotions
Basically – as a mother gets more serious, her dilation is increasing. Naturally (like with noise/vocalizations) this is not true for all women. However, in reading birth story after birth story (and watching video after video) I do see this trend. Mothers start out chatty and light hearted. As the harder work sets in, mothers retreat inside and tend to ignore those around them or get serious in other ways.
This seems to be a very accurate sign of transition for most women. Transition is typically the last stage of dilation and is normally the most intense. It is during this stage that mom may get irrational or scared. Usually this is when women feel the “I can’t do this” emotions and may express sudden fear or want of pain medication. When women are prepared for this stage they can be reassured that this means labor is almost over and baby is near.
Bloody Show
Many women hear about the bloody show at the start of labor. Not all women have this, but it is the “mucus plug”…basically, it looks like a large wad (or wads) of well – snot. I know, not the nicest way of saying it, but it is true. The mucus plug is probably one of the weirdest looking parts of labor and birth. However, around 6cm or so, most women get another (or first) bloody show. This usually comes out during contractions, and may be a gush of fluids and mucus and blood. If a woman’s membranes were broken before this point, she may have another gush of fluid at this point.
Estimate Without Fear
All of these methods can be used to assess progress in laboring women. Some may be more accurate than others, but perhaps we should ask ourselves about why we want to know dilation in general. In some situations the information can be very useful, for instance if a mother does not want to head to the hospital too early or if she is negotiating for more time in labor but does not want a vaginal exam at the moment (or at all).
However, my suggestion is that for the average laboring woman we learn to not equate cervical dilation with progress or lack of progress. As I stated at the start, dilation is only a snapshot of where you are right now and tells you nothing about where you will be an hour from now or even 30 minutes from now. Long labors with slow dilation can suddenly speed up and reach full dilation (and baby in arms) in mere minutes or hours compared to the slow dilation of the previous hours or days. Women who are not dilated or effaced at all during a prenatal appointment can suddenly have a baby in arms an hour later. [Though, prenatal dilation checks are another subject that will need a separate post.] Dilation is simply not a crystal ball.
If you are a mother who wants to avoid cervical checks completely, or wants to know how to assess dilation before your care provider comes (or you go to them), then these methods can serve you well. As always, continue your own research and talk to other supportive women.
Further Reading
Bellies and Babies Blog on Dilation
Science and Sensibility post on the Purple Line
A Midwife’s Perspective on Cervical Exams
Recommended Reading
Cytotec, Birth Trauma, Hypnobirthing and a Healing Birth Center Birth
My CBAVBAC – Cesarean Birth After VBAC
Community Support and Breastfeeding {Make a Difference}
Selah’s Birth Story
A Home Birth Story
Hypnobirthing: A Drug-Free Birth Story
A Long-Awaited Natural Birth: My VBA2C
The Freebirth of Poppy
Battling Hyperemesis Gravidarum
A Restorative Water Birth
70 Comments
Reedu
Super helpful as I prepare for the birth of my second child. Thank you for writing and sharing this, butt cheeks and all. Bravo ladies!
Jenny
So I have a question before a few comments. Does the purple line test work on Plus size women too?
After having two babies now (one homebirth transfer and one homebirth), I can tell how far dilated I am mostly with noise. For me, I know labor has started when I can no longer talk during contractions and standing/squatting is the only position I want to be in. Then once I reach 3-4cm dilated, I can’t talk in between contractions either and will sometimes be vocal during the contraction as well. I puke at 6cm. At 7cm I feel like labor will go on forever and it makes me sad. It’s not that I feel I can’t do it but I just get sad about having to do it. Then comes the urge to push, which is a very distinguishable noise from my normal moaning. With my last birth, the primal, guttural sound that came out of my throat with the first involuntary push caused me to lose my voice for a week.
It’s just nice to recognize my own body’s progression through labor and to know myself.
Mama Bice
I didn’t find any evidence to suggest it doesn’t work on plus size women. 🙂
Teri Kesti
I have seen this on women of many different sizes and it is the same each time…
Kittian
How does this work for women of all colors?
Mama Bice
The studies that I found were done in the UK and on mainly Caucasian women. This was not a purposeful bias – it was simply the majority of the women who came in during this time period (and consented to be in the study) were Caucasian. It would be interesting to hear from midwives who have attended a large number or births for women of color. I would assume that the line would show up for women of all colors, but perhaps it depends on the skin tone.
Yvonne Argent
Hi I’m midwife in NZ and have used this assessment for many years. The purple line comes up a different height on different women so its possible to not always be accurate with dilatation. Also I been present at births of lots of different ethnic groups and there is a change in the colour around the line in the natal cleft. With very dark skin people it is a much darker colour or black line. It needs to be taken in to consideration with lots of other observation of the mother not taken as the one and only means of assess progress of labour
Leslie Cuffee
I have seen it on many skin tones. The darker the skin the darker the line. (I have been a birth doula for almost 9 years.)
Ylia
Hi, I’m a midwifery student from New Zealand in my final yearand I’m most curious about any ways in which we can reduce or avoid vaginal exams. I have seen this purple line in some woman and not in others. I would love this to be an accurate tool, but like you say – in some woman it won’t appear, in others it’ll disappear at full dilation and again in others it’ll start at 3-4 cm. That’s a huge variety, meaning a lot less reliability…I’m by no means advocating vaginal exams, but I think it’s very important to not set women’s expectations so high, that they think it’s this simple, because from experience I can say that it’s not. I think intuitive assessment includes all of the ways you have named. But you don’t measure intuition in cm…! I think if you want a cm result you do a VE. Just wanting women to have realistic expectations, because otherwise it causes unnessessary grief! Thanks for all your research and your very valuable articles, Ylia
Mama Bice
The questions you have to ask yourself (or better yet – the mother) is:
1) What does knowing a centimeter really mean? It is proven that it predicts nothing about how long a mother will continue to labor. The information can also cause a mother emotional distress if she feels she should be further along or is not going fast enough for her provider’s liking.
2) Is the increase in risk of infection worth the check if there is no emergency? Studies show clearly that bacteria is greatly increased with each vaginal exam, and that is not dependent on waters being broken or intact. Every vaginal exam increases bacteria, and therefore increases the risk of infection to mother and baby.
3) Who is setting the woman’s expectations high? Why is the mother being told that her labor is only progressing if she has reached a certain dilation? If a woman knows that her body will most likely do its job – and do it better without hands in her vagina – then she will be more relaxed and dilate better.
We also have to remember that cervical examinations are inaccurate, studies show this time and again.
Sherri
In mamas where the baby is not in optimal delivery position, say “sunny-side up”, after hours of labor, membranes rupturing, yet no changes in dilatation, station, etc. this is a sign that the mother will need an intervention.
VE’s aren’t about knowing necessarily how far a mama is, more so, it’s part of many assessments to ensure mother and baby are okay. I believe most moms can go through labor an delivery without interventions, but with critical assessments, it saves lives.
Ashley
Hours of labor with no change or a sunny side up baby do not need interventions. Sorry to knock that one, but interventions are only necessary if sis harm will come to mother or baby and a stall in labor or a less than optimal positioned baby are not emergencies. :/
Kirsten
I’ve had two ordinary home/water births with posterior “sunny side up” babies with no intervention required. Incidentally I had my first VE at my last birth (which was actually my third birth) at my own request. It wasn’t necessary at all, and I wished I hadn’t. Just for those mothers reading this that may have a posterior birth – it can be done without fear, without intervention, naturally.
Melanie
I am curious about this. Does these only work during labor at full term or are these good indicators for something serious during pregnancy, such as an incompetent cervix or preterm labor?
Sarah K
This is so cool to read! I gave birth to my daughter three weeks ago and my midwives were comfortable and supportive of my desire not to be checked at all despite the fact that I was in denial for the first hour and a half of labor. I got to experience trusting myself and them to judge how I was doing using all of these methods. I highly recommend it! 🙂
Esther
I love your point about dilation not being an accurate estimate of when the baby will be born. With my second, I literally went from 7 cm to 10cm and pushing in 30 minutes (and only pushed for about 5 minutes, and part of that was trying to NOT push because they had to find the midwife).
Christina Ashworth
I agree that dilation doesn’t tell you much, but I want to point out that there are other, more important reasons to check the cervix. One is to determine the position of the baby. If baby’s head happens to be a little crooked, then that would be good to know so the care provider can do some things (like have mother change positions so baby’s head can have more space to adjust to a more ideal position) to prevent the labor from being harder and longer than it needs to be.
LynB
There are other ways of knowing when something is wrong with baby’s position. Pain in labor is a great indicator of baby possibly being malpositioned. Labor puttering out is another indicator.
Christy Porterfield
At my sister’s birth the midwives used temperature changes along her leg- they were experimenting with it and found it very accurate. Do you now much about this one?
Mama Bice
Yes! I have heard that called “Mexican Hot Legs”, since from my understanding traditional midwives in Mexico use this technique often.
Jamie
You probably read this too! Interesting.
Liza
I love this article. I give this article as a handout in every Bradley Class I teach and I share it with my prenatal yoga students too. I wish they would teach this stuff in medical and in nursing schools.
I tell my students to copy the article and give it to their doctors. This is just another way to help reduce interventions and the risks involved. If you want more tips for a safer birth go to http://www.birthclassonline.com to get Injoy’s Healthy Birth guide-6 steps to a safer birth
Christine
Pertaining to the Purple Line…
I’m 38 weeks pregnant. I’m not in labor… at least I don’t think I am 🙂 I was curious and just checked for the Purple Line and I have one that goes up passed the top of my cleft. I have been feeling a bit of pressure so I’m sure his head is pretty low. So, I understand the head station/pressure theory but I’m pretty sure I’m not 10cm dilated right now. I’m thinking the Purple Line has more to do with pressure on the sacrum than dilation. I don’t know… Just an observation. What do you think?
Teri Kesti
a lot of women have pigmentation that is natural stretching of skin in that area…but it should look different in labor…some women’s lines are subtle and some will turn a bright purple/reddish color. I bet you just have pigmentation there and that it will be a noticeable change as you get ready to push your baby in active labor
Chrissie
This is very interesting, and I’d really recommend that expectant mothers read as much as they can to be best prepared. I’ve had three children, and I agree that dilation doesn’t always progress at a continuous speed. I laboured slowly for a couple of days with my first, with no sleep because I was so uncomfortable. On the second day I attended a hospital antenatal appointment. I was devastated to find I was only 2cm when examined!! And even more so when I was told that this was slow labour and that I must be induced 🙁 The same happened with my second – slow labour for a couple of days, but this time I did not have a hospital appointment so stayed home. Once the contractions became very strong, I did go in but was not very dilated. A few hours later my waters broke naturally and I then progressed very quickly from very little dilation to fully! No time for any pain relief at all, and was holding baby shortly after. 🙂
Janelle
I have to say that I am very thankful to have birthed all 4 of my boys in the UK where the primary care is midwife run. All 4 have been born in the hospital, 2 in the delivery suites and 2 in the birthing center (only gas and air provided). I can’t remember having my dilation checked but 1 or 2 times. The midwives have always just watched and listened to what our bodies do. I am expecting #5 in 10 weeks and am excited to see how this one decides to comes!
Kirrilee
I’ve had 5 babies and only once had an internal exam – it was extremely invasive and deflating. Since then I’ve declined. I’ve had 3 homebirths since and my midwife can tell where I am by the noises I make and my manner. In my experience, when I feel that primal urge to push come over me, it means I am fully dilated! Maybe in the hospital situation the fact that midwives don’t actually stay with the woman for more than a few minutes at a time mean they rely on internals rather than continuous observations.
Lisa Sykes Doula
You missed the Rhombus of Michaelis!
http://sarawickham.files.wordpress.com/2011/10/tpm8-the-rhombus-of-michaelis.pdf
Kait
Great post, thank you.
Another useful sign of dilation is the “triangle”. Basically when a woman is fully dilated, or nearly, and the baby’s head is descending into the pelvis, the sacrum (tailbone), which is triangle in shape (with the single point being the end of the tailbone, pointing down towards the anus), pushes outward and is visible on the woman’s lower back. In my experience as a doula and student midwife, this happens just about as often as the purple line.
It’s a great and reassuring way of assessing labour ‘progression’, if required.
martina
Very very interesting!! Thanks<3
David Hayes
A good start, but why not take the next step? Why do we do routine cervical exams at all? As you point out, cervical exams give no predictive information, they don’t accurately tell the mother or the provider anything about how fast the labor will progress or how long it will be until delivery. So why do them?
I have searched the obstetric and midwifery literature and I have yet to see any research that shows a benefit to the mother or the baby from doing routine cervical exams. I would love to see something that suggests a benefit from cervical exams. I know, there are all these charts of labor progress, station versus time, alert lines to cross, etc. But has anyone ever randomly assigned women to either having their cervix checked or not and then looked to see whether in fact there is a benefit to doing it? Not that I can find.
In fact, like many other things in medicine (how many times do we have to surgically deliver an eight pound baby that was thought to be ten pounds before we begin to understand how poor the information we get from an ultrasound – any ultrasound, for any reason, by any operator – is?) cervical exams are smoke and mirrors. They make us think we know something that we simply do not know
There is, on the other hand very good evidence that doing cervical exams increases the rate of puerperal infection. And of course they are invasive for everyone, uncomfortable for most, and traumatic for some.
So all across the world obstetricians, midwives, and nurses are routinely doing something that has no demonstrated benefit and a very well documented harm. What ever happened to “Primum non nocere” – First do no harm?
As Christina pointed out above, there are indeed reasons to do a cervical exam. For example checking the head presentation for an asynclitism that can be corrected or prior to applying forceps. But these are indicated exams, not routine exams. There is a big difference. (And even these indicated exams have not been subjected to scientific scrutiny. Does it really help to correct and asynclitism? How often is it successfully done relative to the number of additional infections it causes? These are questions we should be asking instead of just blindly going ahead.)
So the next time someone, anyone, wants to check your cervix in labor, ask them to explain precisely what the benefit of doing so is. Then after they say “so we’ll know how you are progressing” simply smile and ask to see a study, any study, that shows improved outcomes from “knowing your progress”. That should keep them out of your hair, and your cervix, long enough to for you to focus on the task at hand in peace.
Mama Bice
I completely agree. I don’t think I encouraged the use of cervical exams in the post anywhere? Or perhaps you were just referring to the world in general. 🙂
I did include links to studies showing the harm of cervical checks (infection increase and the inaccuracy). The thing about randomly assigning and doing double-blind studies (the gold standard) in pregnancy and birth is that it is often considered unethical in this situation, where action (or inaction) could harm mother or baby. Hence there not being many studies.
I would argue that a study on cervical checks for position when progress is not happening at all (in other words, mother feels urge to push but it is obvious baby is not moving down despite position change and strong urges) is not needed, as the information gained is obvious – not dilation but rather a possible obstruction. Midwives or doctors can correct the angle of the head sometimes if the mother is dilated enough. They can also hold back or massage a “cervical lip” out of the way when this is needed. These would be indicated cervical exams though, not routine.
I plan to totally decline cervical checks this time around (and my homebirth midwife has no issues with this) unless I feel a strong “gut feeling” to have one done. So trust me, I agree with you that they are not needed – hence this post about other ways to measure progress without cervical checks. While progress is not the same for everyone, knowing that something is happening at the mother’s pace (not a graph on a chart) is important for the mother and care providers.
Polly Malby
My favorite way to check dilation is to look at the circle that shows up around woman’s mouths – I have years of photos packed away but I suspect others have noticed that as the mother progresses in labor, a blanched ring progresses on her face a little ahead of what my fingers told me when checking her.
Ashley
Wish I had read this before giving birth to my three kids. Will be saving this for further reading.
Labor RN
Decent study showing that number of cervical exams do not increase risk of infection.
http://www.neerabhatiaobgyn.com/wellness-news/risk-infection-during-labor-not-influenced-number-cervical-exams/
Mama Bice
Not sure I am convinced by that at all. Other studies (other than the one I linked) show an increase in bacterial colonization after each cervical check. Logic tells us that more bacteria = greater chance of infection. Fever, which is the only indicator that study shows, is not the only indicator of infection either. This particular quote also worries me as to the point they were trying to prove:
“Dr. Cahill said, “Our data would suggest that it’s not the exams, which is certainly reassuring because our best data from modern obstetrics certainly encourages us to actively manage patients’ labors to optimize outcomes and to do this we really need to be able to examine patients and know how their labor is going.”
In other words – they are just happy to know they can continue to “manage” women’s labors and put perimeters on their progress. The data is simply not there to suggest that knowing dilation multiple times in a labor does anything to speed up baby coming out, or improve outcomes for mothers or babies. However, we do know that “failure to progress” is one of the biggest reasons for our current soaring cesarean section rates, and that “progress” is measured in almost all cases by the inaccurate method of cervical exams.
Labor RN
Should have read….
This is a legitimate four-year retrospective cohort study involved all consecutive term singleton deliveries reaching the second stage of labor but you are going to discount it because it doesn’t go along with your logic? Really? Well clinical studies show that all gall stones, kidney stones, or foreign bodies like glass or bullet fragments need to be removed, as long as they are not causing problems. But logic tells us that if something foreign is in our organs or skin and has the potential to cause pain or a foreign body reaction that we probably should have it removed. So do you go ahead and request unnecessary surgery to have these removed because logic trumps research studies?
op
Labor RN is going to remain blind to her bias and let her ego lead. by choice .
lizzie
totally agree with your point about fever. was almost denied antibiotics for acute infected sinusitis recently because i had no fever- i rarely, unless very acutely ill have a fever when suffering from an infection. I also know – having had acute infected sinusitis 6 times in the last 24 months that if i dont get the antibiotics within the first 10 days of infection-fever or not- i WILL be on a months worth of antibiotics because it WONT clear up. I get my fevers at night if i get them, not when doctor or nurse is checking me during 9-5 surgery hours. Fever is not a good indicator of infection of any kind
Jess
I had very irregular contractions with my last baby. I thought things were getting intense but was unsure so I looked for that purple line and sure enough I saw it! It practically met my back! Wasn’t checked but knew the baby was close. She came an hour later!
Labor RN
Your continued comments about the inaccuracy of cervical exams are really quite suspect. I agree that two or three examiners may disagree about how far someone is dilated by 1 or even 2 cm in teaching hospitals, but as in many observations in medicine we follow the trends. In most labors one nurse or resident is the same person examining the patient and that same person can easily determine a change in the cervix from exam to exam. 1-4 cm is easy to tell and 8-10 is easy to tell. No difference between two consecutive exams is easy to tell. Following this purple or red line which is based on venous congestion and not really cervical dilation is an indirect measure of cervical progress where a cervical exam is a direct measure of cervical progress. Following the trends by athe same examiner is undeniably more reliable. If a woman has hemorrhoid, vulvar varicosities, pelvic congestion syndrome, lower extremity varicosities, prolonged labor with excess IV fluids, preeclampsia with edema and other conditions will certainly affect this purple line reliability. But if you check the cervix when appropriate, there is no doubt.
Mrs. BWF
Why do you feel the need to constantly check a woman’s cervix?
Mama Bice
Did you even read the large study on the purple line I linked? They were checking the purple line, and then double checking with an internal exam to prove the accuracy of the line. They correlated accurately. It was not a “guess” – they checked dilation in two ways and the purple line correlated.
Jennifer Burian
Wonderful article. As a labor and delivery RN for thirty years, I can guarantee that there is not a resident in the world who is taught this. I forwarded it to my co-workers, and hopefully we can start using this. Your remarks about the dilitation numbers being an emotional as well as physical hurtle is right on, and causes emotional dystocia consistently. Thanks. JB
Mama Bice
That is wonderful to hear! I love to hear from all the amazing L&D nurses out there who love to look for ways to increase their skills and help mothers have more options. 🙂
Kelly
This is very interesting! When I had my last baby (1 yr ago), I didn’t have 1 single vaginal exam. Perhaps my midwife and doula used one of these other methods to check dialation…regardless, it was nice to not suffer through an exam while in labor! My body knew when I was dialated fully…my body also told me when to push my baby out. Super cool article. Thank you for sharing!
Miranda Sheridan
I was very excited to see this article! The thought of vaginal examination for dilation for me has always been a very uncomfortable thought but if they can check it this way and it is more accurate then I am all for it!! Thank you for posting this.
tecla
Thank you very much for this article. I am intending on getting a vbac with this pregnancy. On my last one I was checked almost every hour and at one point I was told I was 8cm, then 6cm, then 8, then 7, it was all over the place and this was by different people I would have preferred not to have hands up my vagina that often and to be left alone if they weren’t sure. I ended up with a cesarean for ‘failure to progress’. This time I am getting all the information I need.
Viri
This is awsome I’m glad I read this as I’m currently 24 weeks pregnant with my 3rd baby n I don’t like going to the hospital right away for the same reason it’s very uncomfertable .. I pretty much know my body n I’m hoping it goes the same for this next baby ., with my first I didn’t go to hospital till I new it was time too push him out n I was right I got there they layed me in bed n I pushed him out just once 100% natural no epidural .. With my second one I got there n only pushed twice until I felt like my body was ready also no epidural . Sometimes doctors make u push for hours n I think the pushing should start when ur body is ready with my soon to be 3rd baby I told my fiancé that I wanted to wait at home till I’m ready to go to hospital he is okay with my decision .. And I think it’s best for me and the baby .
Nina
Im curious if this will work with a pilonidal cyst. I have had an unroofing so that area has a lot of scar tissue so Im wondering if its affected.
Diane
I wish I had had this information for the birth of my daughter. My daughter was 2 weeks past estimated due date, and my midwife (whom I chose over a doctor thinking they’d be more supportive of less invasive methods and drug usage) was stressing me out with ultrasounds several times a week as my belly didn’t seem to be growing those last 2 weeks, BUT I could feel her creeping up under my rib cage, she was still growing. My midwife said I needed to be induced as I wasn’t “progressing” and she was worried about my baby. So I went into hospital, and they sent a new midwife in for my labor, one I had never met. I kept an open mind and I told her I didn’t want pitocin or oxytocin, she tried to convince me into having it, I said no, just break my water. So she did and very slowly my contractions started and slowly became stronger. And all the while the midwife kept saying perhaps its time you get some pitocin…have you thought more about getting pitocin…what about that pitocin. She completely stressed me out and frankly annoyed the hell out of me. Here I thought having a midwife in hospital with me was going to be good in terms of her supporting my decisions and choices to go drug free and natural. And as my labor carried on she just kept pushing more and more to the point where I broke down in tears and had to explain that I didn’t want to have the drugs coarsing into my baby! I was appalled that she didn’t think of how her actions/behavior and tone with me was influencing my labor and progression. I truely feel this impacted things for me. I didn’t feel supported by her through all of this. It was only after I started crying that she finally backed off and let me try laboring in the tub where I could relax some more. I did progress some more and felt I was close as I was feeling urges to push so she said I had better get out so she could check me and said in a very somber voice, “you’ve only dilated 1 cm in 1o hours, I need to call in the doctor on call now for a consult, as you are almost 12 hours with your waters broken. I was exhausted and feeling unsupported and then when the doctor came in she said that my uterus was exhausted and might rupture now and that she would not allow them to give me pitocin at this point to progress things along. She suggested I have a cesarean, and by that point I felt so beaten and unsupported and they’d scared me with everything they were saying so I conceded and my labor ended up at the opposite end of the spectrum as I’d hoped. All in all the labor experience in the hospital with this midwife was a huge disappointment and it took me a while to get past it and I’m still not completely over it. You should never under estimate the impact of labor on a woman and how she feels postpartum about herself and the idea of subsequent children. Supporters of laboring women, please, please, please, be sensitive to your actions/words/and behaviour; you can be her support or you can be a hurdle for a beautiful experience in which a woman feels supported, heard and loved.
Tabitha Jenkins
I have mt own reasons that VE are completely not accurate. I almost lost my last daughter due to the midwife doing a VE and pronouncing me to be 6 cm then giving me a IV dose of stadol. I had warned her of my propensity for quick labors and still she insisted on giving me the medication. As soon as shifted my position, I felt my cervix conpletly open. The nurse ignored me when i told her I had to push and only acted like she was getting tge midwife. When my mother went to see what was keeping the staff, they wherr standing at the desk goofing off. When the midwife got in the room I was crowning. Mt saughter arrived overdosed and quickly went into cardiac and respiratory arrest, they neglected to follow protocol and bring the required narcan into the room with them. My daughter ended in the NICU for nine days with respiratory and feeding problems. So no dilation is not an indication of how close delivery is.
Chaude
Hi I am currently 38 weeks pregnant. I have had a funny cramp like feeling on the left side of my lower back which descends to my thigh. I have had some cramps in my abdominal area. I have checked for the purple line and can clearly see a dark visible purple line. When do I go to the hospital.
Gaynor
Thank you so much for this information. I will be recommending this to our clients to read.
Lynne
Hello and thank you for the post about the birthy smell. When I first began to ‘smell the baby’ (about 12 years ago), I thought I was having olfactory sensory problems 🙂 Then I began to notice when this wonderful smell came and it was anywhere between 15 minutes and one hour twenty minutes before the birth of the baby. If I do not smell this wonderful and very distinct smell, the baby does not come without assistance. The first person I told was an ob whom I trusted and respected, and to his credit, he heard me out, and he has tried to smell the baby too but you either do or you don’t! 🙂
I trust this so much I talk about it in antenatal and childbirth preparation sessions with Mums and Dads-to-be, and if I am with them in labour, they have often asked me f I can ‘smell the baby’ yet, accepting it (as I now do) as normal and a given. I also discuss this with student midwives – being a midwife is such a sensory thing and we need to be open to, accepting and honest about these aspects of what it is to be with women as a midwife.
In Midwifery,
Lynne
Claire Anderson
I think you can trust your instincts to sniff out when your midwife is full of “BS” but it is all the more painful and harder to deal with when you miss it. Unfortunately I missed it by my midwife who works for a new private midwifery service who the NHS pays for on the Wirral (who was supposed to be my 121 midwife hint hint) and had to birth my stillborn son without her. The SHO, registrar and nurse who looked after me were angels though. My post natal care from my “dedicated” midwife was 2 text messages. My post natal care from anyone else in the establishment was ZIP and hostility. Beware who you put your trust in!!
Caitlin Lark
I love this article. Why do we need to invade a womens privacy so unnecessarily. I am a midwifery student and I have real fear as I go out into my placements that certain protocols I am so against will be forced upon the women I help care for. I have had my own baby and my midwife didn’t do the internal checks. She didn’t need to, she didn’t want to, and I didn’t want her to, I knew what was happening with my body and when I was ready to push I was ready to push. Gentle untouched birth is where we need to get to.
sharon
During my third home birth I checked my own dilation (wasn’t checked in the first two births) and noticed as soon as I touched the cervix it started closing up again. I immediately withdrew my hand (no sane woman wants to do more work in labor). My labor continued and I had a lovely baby girl but I do wonder now how many women have their work load increased by all these dilation checks. I don’t think VE’s are necessary and may well extend labor.
Fiona @ Free Range Chick
I wish I had known about this just over a year ago (just before the birth of my second son). I have brown skin and would have been so interested to see if the purple line could be seen on my complexion. I wasn’t that fussed about internal examinations – I didn’t have many and went on to to have the most amazing water birth with natural third stage and no stitches required. And he was huge. (Can you tell that I’m still delighted with my labour?). What an interesting article. Consider it shared!
Brittany
Ok so I’m reading comments: what’s wrong with sunny side up? I had to google the term and learned then that my son was born sunny side up. The first thing I saw looking down was his face. My midwife never said anything about his birth position. I had no assistance pushing and she stepped forward to hold his head and bring him out of the water to my chest. She never said anything about it afterwards either except the point that my sons head never molded in the birth canal and that I didn’t tear either. My labor lasted 4hours. Walked in at 3cm. Nurse didn’t believe me but I had a feeling so I walked for an hour. Tada I was 6cm. That was my last check. I only pushed for 15mins. So what’s wrong with sunny side up?
Lindsay
Sunny side up means bottom first. If you saw his face first then he was not sunny side up. 🙂
That said, it is totally possible to birth babies sunny side up, but OB’s don’t like to because of liability issues
Mrs. BWF
Sunny side up means posterior not breech.
beverly mayo
Sunny side up means the baby’s face is born up looking at the ceiling instead of facing down looking at the floor.
Jessica Burks
How does this line present in women of color. It is easy to tell on pale skin I see but what would it look like for the majority of women in labor? Any tips for darker to caramel skin tones?
Sveta
My line is MUCH darker than yours and I’m 21, not pregnant…
Kim
article is well done. As a family physician who was trained by traditional ob I enjoy learning about alternative methods to traditional ob. As a side note – completely unrelated to article – Sara has a large dark mole in an area difficult to see on usual exams. I encourage her to have this checked and followed –
Mary
I guess crack isn’t so whack after all ☺️
lizzie
without bogging everyone down with the details of mine and my sisters’ labours, each time my mum found herself trying to get a midwife to listen to her saying that the slow labour that hadnt been progressing had suddenly picked up the pace and birth was immenient- and she found herself ignored at best, derrided and ridiculed at worst- it was because she had noticed the signs without a VE and with me in particular it was the way i was moving and the sounds i was making. when VE confirmed this on 4 out of the 5 births the midwife reacted with shock and panic
F.
My mother, who has been a midwife for 40+ years always told me, if a woman begins to feel sick, she is usually about 3 cm dilated and the sickness and vomiting subsides at about 4 cm.
In France, the time from about 8 cm to fully dilated is called “periode du désespoir” – the period of despair, when the woman thinks she cannot go on anymore.
LiliD
I’m currently 37 weeks, and I’ve been told that I’m going to have a very slow and long labor due to the fact that my body dilated to 3 cm, and then stopped, I lost my mucus plug, and then established the pattern of about every day and a half to two days I dilated about another half a cm, the problem I’ve always had with cervical exams is that I always bleed afterwards, I always cramp horrifically, and they’ve even stopped contractions for me. I had one nurse say she hasn’t ever dealt with someone who’s labor actually stops when getting a cervical check, which is why I refuse them now, my only problem with going by contractions is that mine are always regular and constantly getting worse for hours, before stopping, which is what my midwife says is me dilating that half a cm or so. So I can definitely say that vaginal and cervical exams are something I will most definitely refuse from now on unless its medically necessary.