Cervical checks...need help learning - page 2
I just started (new grad) in L&D,and am not getting how to check a cervix.I felt babies' heads when mom is 7+cm dilated,and thought I knew what I was doing.However,I am not using two fingers to... Read More
Jun 13, '04I am an RN in Labor and Delivery, and I gave birth at my "home hospital". When I had one of my later OB appointments, I went across the campus to the floor storeroom. I stocked up on Nitrazine paper and sterile gloves and towels.
Why?? Because I did NOT want to be bound to being in the hospital at a very early stage in labor. And due to other circumstances, I was having UCs all the time anyway...so I wanted to be able check myself when they became stronger.
My BOW ruptured at home. The first thing I did is grab some gloves and nitrazine and check myself. I wanted to know what "we" would be dealing with.
It's not all that strange to do a self cervical exam though. It helped that I was familiar and comfortable with my own anatomy because prior to pregnancy I used a diaphragm and was accustomed to inserting it and removing it.
I found it easier to do the exam when I was NOT pregnant since, when I was, my big belly was in the way.
If you do the VE now, non pg, non aroused, it's not so hard. Your vagina is shortened when not aroused and though your cervix is generally posterior when non laboring (with normal anatomy), if you bear down, you'll get it. It's kinda cool when you find it.
I recommend that you DO try it. You will also develop a sense of empathy for what your patients are going through (esp. if you're nullip), and you'll understand the patience and gentleness required for the task.
I also recommend that you talk to your patients when you're examining them. Tell them that you are learning, and thank them for being patient. Also instruct them on how to relax, eg I tell my pt's to relax their butts, their thighs and backs (reduces the "kegel-like" tension of the perineum), and to deep breathe. Also let them know if you have to apply more pressure, as in if you check a mom who's cervix is very posterior. Keeping them aware helps them to help you get done a lot faster.
Sorry for the length of the post....
Jun 14, '04I had a female PA several years ago who was prescribing a diaphragm for me and she had me "check" myself. She really believed that to use the diaphragm properly you had to be comfortable with yourself inside and out. This was a strange situation but I have to say it worked. She was in the room and was just very frank with me about it. I absolutely without a doubt know what a cervix feels like!
I tried to check myself when I was close to or in early labor but as much as I tried, I couldn't reach it at that point!
Sorry no advice for what you are really asking.. I'm not there yet but am soaking up the advice.
Jun 14, '04After talking with my preceptor,I found out that I was feeling baby's head,but only through vaginal tissue.Luckily, today this baby had a scalp electrode on,so that guided me a little,but I felt so bad about fumbling around in there(no epidural),that I gave up;knowing my preceptor would be checking,too.
So glad so many of you have responded,I'm learning much more than I probably would otherwise!
Jun 15, '04the old sleeve trick is a good one. But the best practice is on real women. Anesthesized women are best cause you are not making them uncomfortable while you get a bearing on where things are (fetal presentation, direction baby is facing, cervical dilatation and effacement and station). Most women are not bothered by this when they have anesthesia and you can take your time feeling for things. Really, nothing takes the place of practice, practice, practice. Try doing these with an experienced mentor/nurse so you can compare findings. You will get the hang of it before you know it, never fear. We have all been there, new at one time. Hang in there!
Jun 15, '04Practice, practice, practice is correct. I don't know how busy of a hospital you are at, but could you get the word out to the other more experienced nurses? Let them know that you want every opportunity to check women with epidurals. It will also have the other nurses watching out for "interesting" checks for you. Just a thought.