Cervical Exams- locating the cervix

[AvaRN22, MSN, RN]

Hi everyone,

I just recently transitioned into L&D from 4 years of high-risk antepartum nursing and I absolutely LOVE it on L&D! I've been doing L&D for two months now and I am still not 100% accurate with my cervical exams.

I have read almost all of the threads on cervical exams in this forum. But I have a few specific questions. Sometimes when I go in to do my cervical exams it just feels like lady partsl "mush." Its like I get lost in the lady parts and just can't seem to find the cervix sometimes, especially when my patient is 100% effaced. Should I just search right, left, up, far posterior? What do YOU do when you can not find the cervix after searching for a minute or two? Should I elevate my patient's hips to raise the pelvis? Would that make it easier?

Please share your thoughts, tips, and answers.

Thank you very much :-)

[cayenne06, MSN, CNM]

For difficult exams I put the head of the bed alllll the way down and have your patient place her fists under her hips (if possible). Help her relax and breathe slowly, and reaaaaaaach. Sometimes it is really hard. A few times I have been unable to get a good assesssment because of maternal discomfort or habitus, and in that case I just chart the reasons and notify the provider. SVEs are only one way to monitor labor progress, and tbh sometimes we rely on them overmuch.

I've been doing this for 13+ years, and can usually accurately assess a cervix when mom is in all sorts of positions, but I still sometimes can't find it or make a mistake. When I was still orienting at my current LDRP job, I thought a patient was fully dilated, only to have the provider recheck and find her to be 1cm, posterior, and fully effaced! Talk about embarrassing!

[ScrappytheCoco]

If it makes you feel better I am having the same problem! If I can even find the cervix I am still way off on dilatation, I have tried all the tips and I'm just not getting it, ugh!

[labordude, BSN, RN]

I bought one of these Pocketdilationguide.com and it's great. I started off with trouble getting a handle on SVEs, but the one thing that helped me was when one preceptor talked about the cervix as feeling like a small rubber band. Think about the feeling when your finger rolls a rubber band. On my next exam after that it clicked, at least to the extent that I understood better what I was feeling for. I still have trouble sometimes with dilation, but I just ask another nurse to check behind me.