How Do I Know it’s Time to Go to The Hospital?

You are planning on laboring at home for as long as possible, so how do you know when it is the right time to call the midwife or head to the hospital?

Well there are a couple ways. The first way is timing contractions. Many providers will use the 5-1-1, 4-1-1 or even 3-1-1 rule. This means that contractions are 5,4,or 3 minutes apart lasting a minute for at least an hour. Now this can be helpful, but this is not always a good indicator of how progressed you are. 

So is there a more accurate way? Yes!! And it's called the red/purple line! This method is not very well known, especially by doctors, however midwives and doulas have been using it as an indication of cervical dilation and fetal station for years! Basically, as the baby descends lower into the pelvis, a red/purple/brown line creeps up from the anus to the top of the naval cleft (butt cheeks.) This happens because of the increasing pressure within the pelvis, which would account for the correlation between fetal head station and length of the line. If the line is just above the anus this signifies early labor, a line an inch away from the top of the natal cleft means the birthing person is near or entering transition, and a line that extends to the top means that the 2nd stage of labor is approaching within minutes. 

This way of monitoring progression is much less invasive than cervical checks, and guess what, it's more accurate! The red/purple line presents on 89% of women in labor and it is 56% accurate, whereas cervical checks are only 50% accurate, and are not a good indicator about the speed at which you will progress. So I'm sure you're wondering why doctors don't use this method instead of cervical exams. Well, first this information has not made its way into medical textbooks yet, and it probably won't for a few more years, similarly to how doctors are just learning the benefits of delayed cord clamping, but midwives have been practicing this for a while. Second, many doctors and nurses still only see women in labor while they're laying on their back, which makes cervical checks much more convenient. 

If you're planning on laboring at home for as long as possible with your birth partner and doula, this could be a good way to judge your progression. Now, like I mentioned earlier, not all women ever see a line, and for some it's very faint, making it hard to tell progression. But this when paired with timing contractions can make for a better idea of when it's time to call the midwife or head to the hospital. 

Quick Breakdown:

• As the baby descends, a red/purplish/brown line creeps up from the anus to the top of the natal cleft in between the bottom cheeks. 

• A line just above the anus probably signifies early labor, a line sitting an inch below the natal cleft is probably in transition, when the line reaches the top of the natal cleft, 2nd stage is probably a matter of minutes away. 

• This happens because of increasing intra-pelvic pressure as the fetal head descends, which would account for the correlation between station of the fetal head and red line length.

• 56% accurate compared to vaginal exams which are only 50% accurate

• Present on 89% of women in labor.

How to monitor progression using the purple line:

Examples:

@evarosebirth