Assessing cervical dilatation without VEs: Watching the purple line

I often get requests for a copy of a short piece about the purple line that I wrote a few years ago.

It was during a journal’s tenth birthday celebrations and a few of us had been asked to pick our favourite article from the first decade of the journal’s history.

The article would then be reprinted in the journal along with our explanation of why we had chosen it.

Because I picked Lesley Hobbs’ fab article about the purple line, the short commentary that I wrote to introduce it (which has exactly the same title as this blog post, in the hope of saving future interested people time when they are searching for it online) often comes up in literature searches.

In reality, the piece that I wrote (which I’ve shared in full below) was short. It doesn’t add much to the debate, although I have since written more on this topic. In fact, I have a blog post in which I have gathered together links to the resources that I know about.

But I know from my own experience that the only thing more annoying than not being able to find the short piece you’re trying to track down is to spend time and money tracking it down, only to discover that it isn’t the lengthy, helpful article that you thought it was!

So here’s the text for those people who are searching for it and, because I think it’s really useful to revisit and remind ourselves of key areas now and again, I hope this blog post will also serve as a reminder of the value of seeking other kinds of knowledge and looking for non-technological ways of assessing women’s progress in labour.

Assessing cervical dilatation without VEs: Watching the purple line

What an exciting task ~ choosing an article to be reprinted! Having spent the last few years re-reading articles in order to gather the juiciest ones to be part of the “Midwifery: Best Practice” series, I already had a personal list of favourites and the article that I have chosen to be reprinted here is, as far as I am concerned, a real gem.

Lesley Hobbs’ discussion of “the purple line” was originally published in the ‘Midwife to Midwife’ section of the journal, epitomises what was, for me, one of the key strengths of TPM when it was edited by Tricia Anderson and Jilly Rosser. Although Lesley’s observations and reflections derive partly from the results of a study that was published in the Lancet, the bulk of the article consists of her own thoughts, reflections, experiences and questions in this area. It contains the kind of information that midwives often long for, but which isn’t always forthcoming where the emphasis is on highly referenced, academically argued and scientifically based articles.

I believe that this article, along with a few others that were published around the same time, played an important part in enabling more midwives to think about alternative (to vaginal examination) ways of assessing women’s progress in labour. The article generated debate (with some midwives noticing, for instance that the line is sometimes red and faint rather than obviously purple) and has been cited by a number of other midwives who have written about less invasive ways of assessing women’s progress in labour.

Even though many midwives still work under systemic constraints in this area, and may be unable to rely predominantly on alternative ways of assessing women’s progress, the fact that this kind of discussion and information exists is, to my mind, a very important aspect of cultural change. We may well still have a lot of work to do before assessment of the purple line and other aspects of women’s behaviour become generally accepted ways of assessing labour progress, but, if the information and discussion is not there, we have no place from which to even begin the process of change.

Another reason for this article being one of my personal favourites is because of the way it generates excitement. I remember being excited when I first read the article; I had noticed a line on some women’s bottoms during labour, and I had heard another midwife mention the original Lancet article, but I hadn’t done anything specific to follow it up or find out more before Lesley’s article was published.This article acted as a trigger for me to start my own observations, and, as above, it has been a trigger for ongoing discussion and debate amongst midwives; in person, at conferences and on the Internet.

This article continues to act as a trigger for students and midwives today. So much emphasis is placed on citing current evidence that, frankly, today’s student midwives may not often open journals from 1998 unless they are looking for something specific. Almost every time I have suggested to a student midwife that they might like to find and read this article, they come back excited; excited about what Lesley has to say, and excited about the fact that they too might be able to learn just as much (if not more) from observing women as they can from their textbooks. For me, that alone entitles Lesley’s article to a place in this celebration.