Understanding Behavioral Cues
The behavior of the person giving birth can be a valuable cue for labor progress, serving as a compass. However, to use a compass, one needs to understand how it works and interpret its signs. The same applies to behavior signposts during birth. In order to relate behavior to labor progress, the care provider needs to be present during birth, open, and attentive to observe the changes in behavior. Ideally, the care provider should know the person giving birth well, as this allows for a better translation of behavior cues into labor progress. Let's take a closer look at the behavior journey during labor!
Most women start labor with a lot of excitement, sharing the news with friends and family, discussing their feelings and sensations. The behavior signs at this stage are enthusiasm and excitement. If this is the case during labor, it indicates that it's just the beginning, and there is still a long way to go. As labor progresses, the neocortex gradually shuts down, leading to changes in brain activity and behavior. The person giving birth becomes more inward-focused and instinctual. They engage in less conversation, have shorter sentences, close their eyes during contractions, and eventually stop speaking altogether. Rhythmic activities such as swaying or shifting leg positions become more prominent.
A mother who is deep in labor appears as if she were drugged. This comparison is not too far from reality because, at this stage, endorphin hormones are released, aiding in the inward turning and reducing the sensation of pain. Eventually, moanings may turn into deep vocalizations, with sounds coming deep from the throat, and mothers become deeply inwardly turned and almost unconscious of their surroundings. These changes indicate that labor is progressing, and the mother is fully immersed in the birthing process.
Pattern of the Contractions: Rhythm, Strength, and Duration
The rhythm of contractions can also provide valuable insights into labor progress. As labor advances, contractions tend to become longer, stronger, and closer together, until almost the very end of labor. So, if contractions are not evolving and they remain for example five to six minutes apart for an extended period without becoming stronger or longer, it could be an indication of a plateau in the process. However, it's important to remember that every labor has its own rhythm, just as every woman and birth are different. Each woman and birth have their own speed and rhythm. Therefore, it's essential to consider that non-evolving contractions do not necessarily mean a non-progressing labor. The cervix may still continue to dilate. Nonetheless, the contraction pattern can be a useful indicator for labor progress for most women.
A more objective Indicator: The Purple line
Another valuable indicator of labor progress is the "purple line" or "dilation line." This temporary purple discoloration appears in the anal cleft, between the buttocks. Recent research suggests that the purple line is more closely related to the descent of the fetal head than just dilation itself, although these factors are interconnected. Scientists suspect that the purple line occurs due to blood congestion behind the sacrum as the baby's head descends in the pelvis. The pressure exerted on the sacrum pushes the blood outward, resulting in its visibility in the anal cleft. It's important to note that the purple line is more visible in individuals with lighter skin tones and is more commonly observed in spontaneous labor rather than induced births.
A study conducted by Byrne and Edmonds was the first to describe the purple line in a letter to the Lancet magazine in 1990. They examined 48 births and found the purple line present in 89% of the cases. Further research by Shepherd et al. in 2010 investigated the purple line with 144 births, finding its presence in 76% of the cases. They also observed a medium positive correlation between the length of the line and the dilation or descent of the baby, indicating that the length of the purple line can serve as an indicator of labor progress.
While the purple line can be a good indicator of labor progress for many women, it may not be applicable or visible in every case. Asking a laboring mother to expose her buttocks frequently for observation can be equally disturbing as a pelvic exam. However, if mothers are allowed to choose their birth positions freely, particularly on hands and knees or leaning against something, the purple line becomes more visible and can provide useful information to the birth team, alongside emotional signposts and the pattern of contractions.
By observing behavioral cues, paying attention to the pattern of contractions, and considering the presence of the purple line, you can gain valuable insights into the progress of labor. This knowledge can be empowering for you and your partner, as it reduces dependence on medical interventions and allows you to trust your body's wisdom. However, it's important to remember that every birth is unique, and trusting your body is essential.
Byrne, D. L., & Edmonds, D. K. (1993). The purple line as a measure of labor progress. The Lancet, 342(8873), 824.
Shepherd, A., Cheyne, H., & Kennedy, S. (2010). The purple line as a measure of labor progress: a longitudinal study. BMC Pregnancy and Childbirth, 1(1), 9.