Cervical dilitation

  1. hi, i just started orienting in L&D at the end of february. i was just wondering how long it took a lot of you to feel comfortable "checking" patients?? sometimes i think i might know what they are and then the other nurse checks behind me and im right and other times, im wrong. i know it just takes practice...
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  2. 7 Comments

  3. by   webbiedebbie
    Of course everyone is different. I used to practice with the old plastic boards with my eyes closed. That seemed to help alot, although I still had a little trouble with effacement (which is subjective anyway). It took me about 6 months before I felt confident with myself. Even as experienced nurses, we sometimes have difficulties and will ask the pt if they mind if someone else could check them. Sometimes, it irks us when we check the pt and the physician comes in and checks them and tells us something different. (We know better, right?)

    Debbie
  4. by   rUmad2
    Hang in there! I remember asking an OB-gyne about effacement. She told me what really matters is that you can tell the cervix is getting thinner or if it all of a sudden begins to swell somewhere. She was a very down-to-earth person but hearing that from her made me quit trying so hard! She suggested breaking it down into quaters (25%, 50%, 75% and 100%.)
    Practicing with the plastic board does help as everyone's fingers are different widths. See how your fingertip fits into the 2cm..3...I've seen nurses go right to the plastic board after an exam to finish their assessment.
    In time, you will learn your 4 is another person's 5 and yet another person's 3. It all can change with/without a contraction or if the patient has been up walking versus laying in bed. And if we are all honest, there are the patients we were SURE were complete....only later to realize we weren't near the cervix at all. :imbar



    Quote from AmAnRN
    hi, i just started orienting in L&D at the end of february. i was just wondering how long it took a lot of you to feel comfortable "checking" patients?? sometimes i think i might know what they are and then the other nurse checks behind me and im right and other times, im wrong. i know it just takes practice...
  5. by   RNLaborNurse4U
    Quote from AmAnRN
    hi, i just started orienting in L&D at the end of february. i was just wondering how long it took a lot of you to feel comfortable "checking" patients?? sometimes i think i might know what they are and then the other nurse checks behind me and im right and other times, im wrong. i know it just takes practice...
    It's going to take lots and lots of practice to start to feel comfortable. I'm going on 3 years in L&D this spring, and I still have trouble, especially in the 4cm to 8cm range. I'm much improved on effacement and station now. Effacement I usually gauge on a 0/25/50/75/90/100 basis.

    I still remember my first cervical exam ... I guessed she was 2 cm (I don't think I even found her cervix), but she was actually 8cms with a bulging bag. WAY off. LOL

    I've actually started feeling for suture lines and fontanelles now, and trying to guess the baby's position (I have a while to go on this - it's not easy).

    Keep practicing - especially when you have patients with heavy epidurals - they are the easiest to check since you can really poke and feel around and they usually only feel pressure (if anything) when you examine them. (This is not to say to do unnecessary vag exams - only do them as needed, but really take your time when you have moms with epidurals in place).

    Good luck! Welcome to L&D nursing!

    Jen
  6. by   AmAnRN
    i just wanted to say thank you to all of you who have replied .. your advice is greatly appreciated!
  7. by   RWDe
    Like all of you I took for ever to get use to this however even if I do get it right the doctor comes in and contredicts me. So I went on line to see if there was a better way for me to do this (or prove I was right and the doctor was wrong) and I came across a machine that monitors cervical dilation automaticly on a continueous basis call BirthTrack. I have never heard of this system and wanted to know if anyone out there uses the system in there hospital. (It also monitors head station on a continuous basis) If you do use it how do you like it? Is it easy to use?
  8. by   beckinben
    Quote from RWDe
    Like all of you I took for ever to get use to this however even if I do get it right the doctor comes in and contredicts me. So I went on line to see if there was a better way for me to do this (or prove I was right and the doctor was wrong) and I came across a machine that monitors cervical dilation automaticly on a continueous basis call BirthTrack. I have never heard of this system and wanted to know if anyone out there uses the system in there hospital. (It also monitors head station on a continuous basis) If you do use it how do you like it? Is it easy to use?
    I have heard of this, and I will quit doing hospital births if my hospital ever tries to get one of these. This could so easily become the continuous fetal monitoring of the 21st century - more technology adopted without any proof of value. A cervix doesn't know it is supposed to be on some labor curve. Not to mention this exposes everyone to the risks of internal monitoring.
  9. by   Baby Catcher, CNM
    You'll get it. Just hang in there. The most important things to know are; 1. Is the cervix closed? 2. Is she complete? 3. Is dilitation progressing? As long as you feel the cervix is continuing to dialate it doesn't matter if you call it 4 and someone else calls it 5. It's all very subjective.

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