OK, I've searched as I'm sure this thread has been run through the ringer several times - but can't find one.
Any tips or tricks on determining station? I know that if the head is at the level of the ischial spines it is supposed to be considered 0 station, on the perineum 4, etc. But are you actually digging around and feeling those bones? Can you even feel them on most people? I guess I am not pressing hard enough, because I can't seem to feel bones laterally. Can you use the pubic bone as a guide(I can feel that!), or gauge station by how far in your fingers are to baby's head? SG
Oct 26, '06
I've been doing this for 5 years and I still don't know the answer to that question. If a doc comes in a checks a patient right after I do, I always ask what station they are at. That gives me a bit of a guide as to how close my guess is - but it is still just a guess.
Oct 26, '06
I have a hard time w/this after 9 years in it...and like dilitation determination, it can be subjective among provicers, I have learned.
I have just come to determine this by feel most of the time. We have so many big people that make it hard to really be perfectly accurate most of the time. Now, Zero is very easy for me---as are +1, +2 and so on---usually. I have a harder time with negative stations....I often what to just chart "too dang high to reach" rofl.......
Sometimes, I do just chart "high and ballotable", if I can't reach (I have very long fingers) then the baby is very high like -3. Usually if engaged and non-ballotable, the baby is at least at zero station. Beyond that, it just takes a lot of practice and even if you have to, using illustrations from your old OB textbook to help you along. You kind of have to picture the landmark in certain people to do anatomical variations.
Does this make any sense at all?
Last edit by SmilingBluEyes on Oct 26, '06
Oct 26, '06
This is something I was never taught either, and with only 18 months experience (has it been that long?), I still ask whoever else has checked the pt before I declare myself.
My best guess for higher than 0 is if I can fit my fingers between the ischial spines and the baby's presenting part but only just, I say -1. Too high to reach = "tonsils".
Continuing with SVE's - am I the only one who has trouble with determining position as far as OP, OA, acynclitic? Especially on a pt who is intact?
And one more question before I go off to bed. Has anyone seen or used a (please pardon the crudeness) "crotch box" for practicing SVE's?
sorry had to edit an expletive for TOS compliance...
Last edit by SmilingBluEyes on Oct 27, '06
Oct 27, '06
Yes, where I work we have a "crotch box". It's pretty useless if you ask me. I've been doing OB for almost 20 years now and when I took a new job 8 years ago, during orientation they brought this big, plastic, smelly thing out to make me perform vag exams on. I'm sorry, I've never felt anyones
cervix that remotely felt like that box!
Also, I agree, station is really a subjective thing. Does it really matter if the patient is -3 or -2? Just like dilitation, my 3cm could be your 4cm. Who cares? I always tell the new RN's it's important to know the difference between 5cm and complete, -3 and +3! And if you're checking pretermers
it doesn't hurt to get a second opinion if you're not sure
Oct 28, '06
Thanks for the input! I am still wondering if you gals are actually able to feel the ischial spines? Maybe I should press more firmly. I have no problem feeling the pubic bone however, so I think I'll pull out the old A&P book and refresh the image of a pelvis in my mind like smilingblueeyes mentioned. Thanks! SG
Oct 28, '06
I agree station is very hard to determine. I've been doing this for almost 4 years and while dilitation is and effacement is fairly easy for me I still use the old way too high, still pretty high, rupturable, and low as my stations
Oct 29, '06
It causes some extra discomfort for the patient to feel for the ischial spines, so I only do it when I really need to know the actual station without a doubt. Usually I estimate it by how far I have to reach to get to the head.
Practice on patients with working epidurals to feel the spines and remember that they are not located at 3 and 9 o'clock, but at 4 and 8. They are very prominant on some women and very blunt on other women. Like everything else, it comes with practice.
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