[malibu03]

Hi everybody. I am a grad nurse working in OB, I'm in month 4 of 6 months of orientation. Basically I'm on my own for inductions and spontaneous labor, and just ask my preceptor an occasional question and usually do pretty well. Yesterday was a different story--induction on a GDM patient (primip), not quite 39 weeks, 2-3/50/-3 at time of admit. Started on low dose pit, long story short was that at shift end yesterday, she still hadn't delivered, and was 7-8/90/-1. I called the night shift nurse a few hours after I got home to check patient's progress, and was told that her cervix was not 7-8 as I thought when I left, but more like 5-6, confirmed by the new nurse and doctor.

I have always been pretty much on target with my dilatation checks, so I'm not quite sure what happened. I feel terrible and somewhat mentally challenged. The patient is fine and delivered vaginally later that night.

I just ordered a pocket dilation guide online and I regularly compare my measurements to the chart we have on the unit.Does anyone have any suggestions on improving my dilation measurement skills? Any help appreciated!!

[MamaTheNurse]

just keep practicing - once in a while, you have an off "check" - I wouldn't worry about it if you are correct most of the time - sometimes, the patient's anatomy just doesn't match right with your anatomy! one time, me (I had just 1 year experience) and another nurse (with at least 10 years experience) were approx. 2-3 cm off from another nurse (with lots of experience) and the doctor and things worked out fine - just keep practicing, practicing, practicing - does your unit have those plastic charts that you can feel effacement and check dilation? it helped me to close my eyes and practice on those - also, if you haven't already done so, measure your own fingers so if someone says, for example, "she's complete" but you know that at 10 cm, your fingers are almost painfully spread apart (I have little hands - I knew it was time to tell 'em to push when my hand cramped during the vag check!) and that's clearly not the case when you check, you know you need yet another opinion (although I'm not advocating 10 people doing vag checks on patients with ROM every hour!!)
positioning can also make a difference sometimes - just the slightest change in angle can affect cervical angle and how thoroughly you can check - I used to report dilation and effacement but also tell what position they were in when I checked (flat, fists under lower back, bedpan under butt, standing on head, whatever)
don't beat yourself up about it - sounds as if you are doing great especially if you are a new grad!! just keep practicing!!!!!

[HRTTX]

I wouldn't stress about this at all. I've seen different Dr.s make calls like this on the same pt.. It's not like you had her pushing. There are to many other things to worry about in OB. Good for you in getting an OB job as a new grad, sometimes hard to do. Hang in there.

[SweetieRN]

I do not work L&D, but occasionally get a cervadil induction or an IUFD. I always have the docs check or a more experienced nurse (I have only been working high risk OB for 18 months), because I have very small hands. I am hoping to get better at it though!

[SmilingBluEyes]

Forget the dilation guide. You know that monitor paper on your fetal heart monitor? The one-minute blocks that are outlined by BOLD lines that represent 60 sec/one minute? Well---- put your fingers on there; and guess what, that is 4 centimeters. If in doubt, I have been known to use that paper as a quickie (and free) guideline on more than one occasion! Also, if in doubt, never be afraid to get a colleague to check behind you, just to be sure! After 8 years, I still do this from time to time. No two women are exactly alike, physically, ya know.

[malibu03]

Thanks everybody, for your kind responses. I did hear the thing about the monitor paper before, and have used it. On our unit, we have a laminated paper chart that I use to compare finger spacing to dilation cm. I thought I was on track, but not so. We don't have the plastic one with the ridge around the perimeter, but I have seen those.

I have had pt's put hands under their bottom, but have never tried the bed pan for a posterior cervix, I may try that.

OK, now only two more months to go on orientation. Yikes!!

Thanks again for your replies!

[KellyLynn]

[quote=SmilingBluEyes]Forget the dilation guide. You know that monitor paper on your fetal heart monitor? The one-minute blocks that are outlined by BOLD lines that represent 60 sec/one minute? Well---- put your fingers on there; and guess what, that is 4 centimeters. "

Pardon me but it is 3cm/min in the U.S.....not 4cm

[SmilingBluEyes]

yep you are right; that must have been a misstyping or maybe done before I had my coffee.....3cm is right, not 4! ty!!!!!

[SelectRN]

Yep, I went ahead and spent money on a Pocket Dilation Guide, and I love it! Quite a few nurses where I work have them, (the perinatal educators give them out to new nurses) and we all like them. Even after many years in OB I use mine regularly. I know checking dilation is not an exact science(maybe I'm a little more anal than most), but I like having a guide to pull out of my pocket and reassure myself with or hand over to the medical students or new residents. The patients like seeing their progress too. I learned with the plastic charts and that was great to have, but I hated not being able to find one all of the time. Next time someone challenges your exam you can just pull it out of your pocket and hand it over. Sounds like you're doing great to me!