I just figured I would start a thread that will be good for students to read also. At our facility, we really keep vaginal exams to a minimum. They really are not necessary much, anyway. In my childbirth classes, I also teach about how frequent exams can increase the risk of infection, etc. Consequently, we do as few exams as possible (that includes the docs and the midwives)
on my unit. What are the rest of you out there doing as far as frequency.
My motto always is "if the head hangs out, she's fully dilated." There is no need to know that she was 5,8,or 9 cm in the process because it really doesn't matter. Our docs pretty much stay away until we cal them (for the birth). :hatparty:
Aug 15, '04
Minimizing vag exams makes so much sense, for obvious reasons (to me, anyhow).
I prefer to NOT put a mom in discomfort for NO good reason. Vag checks can be supremely uncomfortable or painful. We need to remember these are human beings we are treating, not lab rats for experimentation or practice.
Also, to keep chances of infection down, minimizing vaginal exams is a must. No matter that you have a sterile glove on, and use sterile technique; MOM is NOT sterile and any microorganisms in/around the introitus will be advanced up with each vaginal exam/instrumentation (internal monitors, etc) done. Our doctors do differ in opinion from me. They want vag exams q2 hours while a patient is in labor, so as to see if they fall off the Friedman Curve. I think that is a bad idea and I was trained quite differently. Some people WILL fall off the curve, only to "break free" and proceed rapidly later on. This is something I observe time and again, especially after a person reaches 4-5 cm in dilatation. Only a couple reasons exist that make me want to vaginally check my patients:
1. The Mother feels "different" or "pushy" or lots of pressure. Moms are instructed to report these things to me, especially if they have labor epidural anesthesia. If Mom feels "different" or vomits, there is a BIG clue to check things out. (duh heheeh)
2. Baby looks bad on the monitor, e.g. repeated decelerations that are variable or late in nature. May indicate quick progress, or not-----but you need to know progress when fetal or maternal status changes. It can be based on these findings, what interventions must be undertaken and what can be put on hold for the time being.
3. To establish a baseline------often I will ask them what the doctor found their dilatation to be in the office and then I check them initially (IF contracting/to rule out labor) to see if there is significant change.
I believe, especially when membranes are ruptured, it is critical to minimize putting our hands in the vagina. I read someplace (can't remember where)---statistically, we have roughly SIX checks before we significantly raise the chances of infection in the mom. Bad deal and not worth it to me.
The experienced clinician knows labor progress can be measured other ways: e.g. how a mom feels, by the way the fetus' heart tones look on the monitor, etc. Time and nature take care of it in most cases, IF we let them. My rule is: NOT EVERYONE is a textbook case, so do not treat them as such. It's critical to develop strong clinical/assessment skills in order to assess progress in labor. It takes time and work, but it's worth it.
Last edit by SmilingBluEyes on Aug 15, '04
First of all -THANK YOU. I try to minimize my SVE's at all costs, and have miffed at least one doc in doing so. (Now, part of that may be that I am not completely confident in doing vag exams yet, but that's beside the point!
) No, seriously, though - it is the same treatment I would want for myself and my family members, so . . .
Secondly - as a new grad who is in the next week or so coming out of orientation - use your experienced nurses and charge nurse as a resource! To be perfectly honest, I just two weeks ago started to feel more comfortable with my vag exams (actually, now that I think about it, I am darn sure when I'm feeling 4cm, but I'm not sure if I recognize anything higher!:imbar ) Anyways, everybody knows that that's not something you "get" right away, and most nurses are more than willing to help! Good luck!
Edited to say: And what is up with pushy family members, anyway????? It's like, "chill, you're gonna be here for a while."
Last edit by RaeT,RN on Nov 13, '05