Any tips for finding the elusive cervix?

  1. I am a relatively new grad (May 04) and took my first RN job in Labor and Delivery. I finished my "orientation" period in October, and so far so good... I have a long way to go in many areas, but I do feel like I am progressing at supported and not overwhelmed.. all that good stuff.

    My problem is I am still finding some cervical exams really difficult. I work nights, and do a lot of inductions, so a lot of gels, and every once in a while, I just CAN'T find that dang cervix. Then I get the more experienced nurse to come in and do the check, and describe where she found it. THis happened twice last week and it's killing any little bit of confidence I was starting to get.

    So I would like to arm myself with little tricks -of -the -trade that I can use BEFORE i call in the other nurse. I know about the hands under the hips to create more of a tilt, and I think that is about it. Are they ever so high that I might not be able to reach them? Any pt postioning tips?

    Thanks for any input. I really want to find it myself.

    April
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  2. 11 Comments

  3. by   SmilingBluEyes
    I have a fairly fail-proof method (having long fingers does not hurt me either)

    When checking ANYONE I do the following:


    Try to start with warm hands, if possible, before donning sterile glove. This relaxes the mom and makes checks easier for her to bear. I also am very slow in what I do, very gentle and explain each step before I do it. The more a woman is comfortable/relaxed, the more she cooperates. The easier it is to check her.

    Always lower the head of bed as low as possible.

    Have mom place her hands under her hips or use a bedpan and pillow under her hips. (to elevate pelvis more).

    Have her put her ankles/feet together and knees wide apart.

    Go in with my hand, following the curature of her back, reaching along the posterior wall of her vagina, til I reach the fornix, then I move gently forward/anterior with my fingers, til I find the rim of her cervix. This allows you to find the "posterior" cervix---- you know , the one behind the presenting part that is so elusive. lol. Extremely posterior and high cervices are my biggest challenge

    I never fail going posteriorly first, then forward/anteriorly. If you can't still find it, or are unsure, have a little more experienced colleague try and help you out. To this day, if I am unsure of a check (everyone is different and anatomy can stump anyone), I will not hesitiate in having someone else check behind me.


    Doing the above you should find MOST cervices pretty quickly

    I cannot over-stress: be gentle. What becomes "routine" to us OB nurses, NEVER is, to a laboring/ expectant mom. The more gentle you are, the easier it is for her to cooperate and trust your touch.

    It's true that practice makes perfect. You will get this "Down" as you do it more and more. Hang in there and good luck. And welcome to OB!
    Last edit by SmilingBluEyes on Feb 17, '05
  4. by   bagladyrn
    Try putting a bedpan, the "fracture pan" type, upside down with the higher part towrd the foot of the bed under the patient's bottom. This tilts everything forward the same as putting her fists under her bottom, but a little more so. Then put your fingers all the way up and to the back and work your way forward. You can also take your other hand and put gentle pressure on the fundus to bring the head down. (This is not the same as the "no fundal pressure" rule when the patient is pushing.)
  5. by   jennobrn01
    good tips given already!

    mild fundal pressure can help

    going over to the left or right...sometimes it is displaced a little

    practice, practice.

    go in confident

    there's nothing like finding that hard to reach cervix...like that satisfying "pop" when you start an iv.
  6. by   cokegal19
    This is a little OT, but once you find the cervix, how do you tell how many cm she is? I've always wondered this.

    When I graduate, I would like to work in L&D.
  7. by   SmilingBluEyes
    Practice, practice practice. There is a guide to go by that we can use with our fingers to learn what 1, 2, 5cm, etc FEELS like. After a while you know w/o looking.
  8. by   BETSRN
    Quote from AprilInAZ
    I am a relatively new grad (May 04) and took my first RN job in Labor and Delivery. I finished my "orientation" period in October, and so far so good... I have a long way to go in many areas, but I do feel like I am progressing at supported and not overwhelmed.. all that good stuff.

    My problem is I am still finding some cervical exams really difficult. I work nights, and do a lot of inductions, so a lot of gels, and every once in a while, I just CAN'T find that dang cervix. Then I get the more experienced nurse to come in and do the check, and describe where she found it. THis happened twice last week and it's killing any little bit of confidence I was starting to get.

    So I would like to arm myself with little tricks -of -the -trade that I can use BEFORE i call in the other nurse. I know about the hands under the hips to create more of a tilt, and I think that is about it. Are they ever so high that I might not be able to reach them? Any pt postioning tips?

    Thanks for any input. I really want to find it myself.

    April
    Cervical exams just take practice, that's all. Be patient and it will only get easier!
  9. by   ldnurse7581
    I know EXACTLY how you feel!! I would always second guess myself and i would want a second opinion from another nurse,and sometimes still do, and my nurse manager told me i need to build up my self confidence, but it has been getting easier, and i am sure it will for you,too! good luck!
  10. by   AprilInAZ
    You guys are wonderful! I tried the starting posterior, then moving anterior method last week, along with warm hands, slow and describing and had MUCH success.


    I do WISH my fingers were longer.

    Thanks again.

    April
  11. by   SmilingBluEyes
    Can't change the length of our fingers, but we can do the things above, and usually succeed. Keep on trying, Rome was not conquered over night was it? And if you need anything, please ask.
  12. by   ShannonC
    When I was a new nurse, one of the people training me said that it takes 100 VE's until you "get it", and she was totally right. It just simply takes time. Maybe not 100 exactly of course but the idea is right--the more you do it, the better you'll be.

    That said, I agree with the tips give so far. I ALWAYS have the patient put the soles of her feet together and knees wide apart, and she's always basically flat in bed. I find with this positon, I pretty much never need the bed pan or hands under hips. I always go very VERY slowly (the warm hands is a great tip--I'll start adding that), and I try to go down first, like the others have been saying. The bottom of the vagina is much more "spongy" and has more give, so I find I have more room to sort of manuever (sp??) that way. I hope this makes sense.
  13. by   ldrrn
    I have been an L&D nurse for over a year, however I worked in a teaching hospital and never did vag exams. I am now in a very busy community hospital and I am convinced these women are all minus cervices!!!! Please help......All I can feel is lots of heads or lots of lumps. Okay maybe an occasional os. I know this ? has been posted before, but can we go over it again...from the top (or shoud I say posterior???)

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