4 Ways of Assessing Labour Progress

There are lots of clues for a layperson to guess whereabouts in the labour process a labouring woman might be. This is useful for birth partners. Dads-to-be can sometimes feel out of the loop or disempowered. Being able to make an educated estimate can help to prevent those feelings. It helps them feel calmer and more confident, so they'll be better at providing support.

This is useful information for women to know as well, but it's more useful antenatally, as you prepare for birth. During the process, you are unlikely to remember this information as labour intensifies.

Here comes the disclaimer

The information is intended on a peer to peer basis. It is intended to complement, rather than replace medical advice.

1. Hot legs

As your labour progresses, blood is pulled from the extremities and redirected to where it's needed more: your womb, baby and placenta

This can leave your feet feeling chilly. You might or might not notice this (pack some fluffy socks just in case!)

As labour progresses, this extends from your feet and ankles up your lower leg. This corresponds loosely with dilation. If your feet and ankles are cool to touch, you're likely about 1-2 cm. If the lower half of your calves feels cool to touch, you're probably around 4-6cm. If your leg feels cool all the way up to your knee, that's a positive sign you be 8-10cm.

The downside: It's not useable if you're labouring in water.

More info here.

2. Purple line

This is the bottom of a labouring woman, she seems to be in water.

The focal point of this image is "the purple line". The further up your buttcrack this line extends, the more dilated you are.

This is a way of assessing progress that doesn't involve touching you or disturbing you in any way. Lots of women naturally labour in a position where the purple line is easy to see. This is great because some people prefer not to be touched during labour. The purple line is something your birth partner can clearly see, too.

The downside: It has a pretty good rate of accuracy, although not 100%. Mind you, vaginal checks aren't 100% either. (If your baby is positioned "back to back", it might not be as reliable.)

More info: Evidence for the Purple Line

3. The Fundal Gap?

I don't know if this one has a name. I'll just call it the fundal gap.

When you are lying down, you can place a hand just above your bump. At term, when you are lying on your back, the gap between the top of your bump and the bottom of your sternum is about 5 finger-breadths

As labour progresses, there is less space here. At first you'll be able to fit four fingers, then three, then two, then just one.

The nifty part is that this correlates with dilation.

This is because as vertical muscle fibres ripple upward, pulling the cervix out of the way, your fundus thickens. By the end of the first stage, it's a thick, strong pad of muscle to help power your baby down and out.

The downside: it needs to be done while you're on your back. At the peak of a contraction, no less. I cannot think of many things less comfortable! Most mums only remember things like this in the early stages, anyway, so if you're still "with it" enough to try it, I'm gonna take a wild guess there is probably still a 3 or 4 finger-breadth gap there. I could see it being more useable if you have an epidural. Try to change position afterwards.

4. Timing Contractions

This is my least favourite option. It's a perfect way to make you feel observed. This causes a rise of adrenalin ("nature's breaks") and a drop in oxytocin (the contraction-causing hormone). To put it another way, a perfect way of slowing things down.

a watched pot doesn't boil

There's a tendency for birth support to fall into the trap of being more focused on the clock or the app than the labouring woman. This causes oxytocin to really plummet.

Often, first time mums are advised something like, wait until contractions are 5 minutes apart and lasting a minute and doing that for at least an hour... (Second timers being advised something like 7:1:1)

Every birth is unique. I know of mums-to-be who, if they followed this advice, would be attempting to go to hospital far too late in the process, and others who would be going far too early.

It's handy info to have if you're about to call your MLU. What your contraction pattern is like is a useful clue for them, given that you're not in front of them to assess based on other signs. It's just one piece of the jigsaw, though, and a detailed minute by minute approach is probably unnecessary. Ideally your partner can time them unobtrusively for a short period, or just make a mental note of the general pattern.

For example, when contractions are erratic, and when they seem fizzle out when you move about or have a bath.... this is still early in the process.

When they become more sustained, when you or your partner notice an obvious pattern, labour is becoming more active.

Typically, in advanced labour they do usually get longer, stronger and closer together. This should be noticeable even without an app.

If you notice they're very strong, but erratic, this is sometimes a sign your baby might not be positioned "optimally".

The downside: this one is pretty much all downside! It's intrusive, provides limited info, especially by itself, and it can sometimes be uncomfortable.

_________________________________

That's all for now. This isn't an exhaustive list. I'll do another post on this topic soon. Thank you for reading! I hope you found it helpful or interesting. Please do share it - someone you know might benefit!