Feel really stupid for asking this regarding dilation...

  1. Ok,

    Like I said, I feel really stupid for asking this as I've been doing L&D for >1 1/2 years. Not that that's a long time, but I'm not a brand spanken' new OB RN either.... The other night got so busy and I was going to ask the resident who checked 1 hr after me...

    Please, I can't visualize the anatomy of how the cervix can be BEHIND the head??

    I checked a patient the other night, thought she was a 6-7. I thought there was quite a bit of caput and besides the caput I thought the rest of the head was at -2. Resident comes in about 1 hr later says it wasn't caput I was feeling and the baby was actually about -1 and mom was dilated to 4! What the heck??

    So, like I said, we were crazy busy the other night so I didn't feel like it was the time to ask for a lesson on the female anatomy at this time. How can the baby's head be lower than the cervix? I feel really dumb right now, but I need to learn this. LOL! Help! Please!
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    About jenrninmi, MSN, RN

    Joined: Oct '03; Posts: 1,979; Likes: 97
    Specialty: 11 year(s) of experience in L&D


  3. by   cjmjmom
    Wish I could help but the only L&D I have ever had was in school and when I delivered! Just wanted to comment about your comment of feeling stupid. DON'T feel stupid! At least you have the courage enough to ask! If you don't get your question answered here ask the resident that made the comment, he could have misspoke!
    Last edit by cjmjmom on Jul 8, '08 : Reason: spelling
  4. by   RNmama05
    My first thought is: How do you know the resident was right and you were wrong? Vaginal exams are very highly subjective.

    Station (descent), dilation and effacement are related but independent processes. A baby can descend into the pelvis and press down into the vagina without coming through the cervix, i.e., still inside the uterus. Does that make sense?
  5. by   mommy2boysaz
    Not saying that you or the resident were right. Obviously, I have no idea!

    But the cervix can be behind the head. Imagine the uterus as an inflated balloon with the part that should be tied as the cervix. Now imagine it filled with the baby. If the uterus is angled more with the fundus to the front of the mom, the cervix can slide around to the back. It is hard to describe! If I could draw an oval uterus on this page and mom is facing the right side of the page (on your right), her fundus would be at 2 o'clock and the cervix might be at 7 or 8 o'clock, even though baby's head is still at 6 o'clock. Am I confusing you even more??

    Basically, if you're not sure of your VE, especially if the head is super low, walk your fingers back "behind" the baby's head and feel for the edge of the cervix, in case it is back there.

    Either way, don't beat yourself up about this! No one is perfect!!
  6. by   jenrninmi
    I think I've finally got it! yeah! I can visualize it now. mommy2boysaz, I think your description you gave made so much sense! You guys must think I'm so dense! :uhoh21: LOL! I don't know why I wasn't visualizing it before...thanks guys!
  7. by   babyktchr
    Those pesky posterior cervix's. Sheesh. Always make a habit of going back there with your exams, even if you think you have already felt the cervix. Sometimes those vaginal folds can feel so much like a cervix. Hard to imagine that it is behind the head, but once you have felt enough of them, it makes sense.
  8. by   mommy2boysaz
    Please don't feel stupid for asking!
    I have 11 years in OB and I still occasionally do a VE and have no idea what the heck I'm feeling! Then I get one of the other nurses to double check me.
    It's a learning process every day!!