The purple line: an alternative to internal exams in labour

the purple line
Livia Gamble

While internal examinations are standard practice in hospitals, it’s not the only way to determine how far along a woman is during labour. In fact, some care providers use something known as the purple line.

What is the purple line?

According to midwife Dr Sara Wickham, the purple line (sometimes red), appears in the anal cleft during labour.

“In early labour, the line is short, and it gets longer as labour progresses. Some midwives are good at telling how far along a woman is in her labour by looking at the purple line,” she writes on her website. 

Interestingly, researchers set out to determine if a “relationship existed between the length of the purple line and cervical dilatation and/or station of the fetal head.” 

They found that when the line is present, “it may provide a useful guide for clinicians of labour progress alongside other measures.”

Is the purple line accurate?

Tylah McConnell is a midwife based in Sydney. In our latest TMB TV interview, she said the purple line is definitely real for some women, “but it can’t really be used as a clinical indication [for labour progression].”

If you’re hesitant about internal exams, Tylah says there are other external factors a midwife can use to examine a woman’s progress.

“One of the most obvious ones is behaviour. So a lot of women at that six to seven centimetres mark will feel this complete feeling of overwhelm, and they’ll take their clothes off. They’ll want to go home. They’ll ask for the epidural. To us, that indicates, okay, we’re at six to seven centimetres. 

“If a woman’s chatting to us and sort of having a good time, we know that’s probably most likely early labour. If she can keep talking to you through the contraction, we’re probably looking at two to three centimetres.

“That being said, every woman’s different, and they do constantly surprise us.”

Tylah adds that internal examinations are sometimes used for other factors other than determining how dilated you are. 

“We mainly use it for decision making,” she says.

“If we see that you’re involuntary pushing, we might want to get an internal exam. Not just for the sake of it, and not just for the centimetres. But because we want to know that all the cervix has disappeared and you’re not pushing on the cervix or making it swollen – and ultimately slowing down the birth process.” 

You’re well within your right to ask questions

Tylah says women have every right to ask your midwife questions about what’s being done to them while giving birth

“Don’t stress about asking why – you’re well within your right to have that discussion. But say, ‘I’d be happy for that, but I’d like an explanation to know what you’re looking for, why you’re doing it and what you hope to achieve from this.’ You can always ask why. You can ask, ‘can we wait two hours?’

“I wish women would understand that you do have control of this. It isn’t happening to you. You are in control.”

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