[Calzonan RN]

I am in my last week of orientation on L&D and am feeling pretty comfortable in most areas. The one area I'm concerned with however, is SVE's when the pt is cl/th/high. I've got short fingers, unfortunately, and there have been a number of times when I haven't been able to reach a woman's cervix because of this. I've had my preceptor there and she's been able to check behind me, but I'm really worried that once I'm off orientation and I get a newly admitted pt or an induction, I won't be able to reach her cervix. Does anyone have any suggestions? I've tried the fists under her hips, and sometimes can reach it then. I'm so scared I won't make it as an L&D nurse because of this. On a side note, once they're starting to dilate I usually have no problems finding their cervix and have been completely accurate in my assessment of their dilation etc, it's just the ladies where you feel like you're reaching for their tonsils that I have problems with.
Thanks for any advice!!

[elliebellie]

This is not just a "new nurse" thing! I have very short fingers and sometimes I just can't find the darn thing even after all my "tricks". Sometimes it'll be anterior but because it's so high I'm trying to find it posteriorly & I'll miss it. Take your time, go slow & if you still can't find it, ask someone with longer fingers to check.

[BirthCenterRN]

I am a new LD RN (1y) and I often get called in a room by experienced nurses because I have longer fingers. I used to think "you want the newbie to check someone" but I was always accurate and they trusted me.

[gemininurse71]

Try a clean bedpan (not fracture pan), upside down with thicker part toward the feet and covered with a pad while pt totally flat in bed - it is awkward, but tilts the pelvis well. You can also carefully apply firm fundal pressure.

Alison, RN L&D

[l&drocks]

It is hard to check someone who is way posterior. But, rest assured if you are having that much trouble reaching there cervix, they will not deliver any time soon!!

[stutz5608]

Anytime I can't get to the cervix I do what gemininurse 71 does and I put my patient on the bedpan. I also lower the head of the bed so the head is flat or slightly lower. It really does make a difference.

[Jolie]

I don't mean to sound flip, but if a patient is so high/thick/closed that it is virtually impossible to assess the cervix, is a cervical check really all that necessary?

If a patient is that early in labor, why subject her to the discomfort and risk of infection of repeated vaginal exams?

[Spidey's mom]

Originally Posted by Jolie

I don't mean to sound flip, but if a patient is so high/thick/closed that it is virtually impossible to assess the cervix, is a cervical check really all that necessary?

If a patient is that early in labor, why subject her to the discomfort and risk of infection of repeated vaginal exams?

Great advice~


steph

[christine_chapel]

Originally Posted by Jolie

I don't mean to sound flip, but if a patient is so high/thick/closed that it is virtually impossible to assess the cervix, is a cervical check really all that necessary?

If a patient is that early in labor, why subject her to the discomfort and risk of infection of repeated vaginal exams?

I've had plenty of multips who dilated as much as 6 cm while their cervixes were still very high and at least 50% effaced. When a lady like that makes her move, she MOVES!

However, there are plenty of times when I'll document and tell the MD that the cervix is extremely high and posterior, and seems thick, but that I could not confirm dilation. If this is the case, then it's usually not worth the intense pain to the patient just to satisfy our curiosity.

[crissrn27]

I am another short fingered one, lol. I always had luch with the pt on the fist and then slight fundal pressure.