Manual dilatation of cervix

  1. We had a pt. on our unit,G5, P4 , who had all SVD's previously and was term , came in having uc's q 2-3 min x3-4 hours, palpated strong, but never had any cervical change over 3 hours and was given MS 10 mg and was sent home. She came back in 8 hours later, same ctx pattern, still palpating strong and no cervical change from prior exam, 3/80/0, at this point she had SROM, clear fluid. Come to find out she had cryotherapy on her cervix since her last delivery, so her physician manually dilated her to complete with cervical dilators and she had a healthy baby. Has anyone else ever seen a physician do this before? It's not common practice at our hospital.
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  2. 9 Comments

  3. by   canoehead
    I once saw a doc manually dilate from 6 to fully and from the woman's reaction it was excruciatingly painful. I would imagine he was risking a cervical tear, and defitnitely would have expected some kind of consenting, but he didn't even tell them what he was going to do. It was late in the day, so I suppose that had something to do with it.

    Interestingly that woman also had a uterine inversion when they tried to get the placenta out and a pp bleed. Perhaps her body wasn't quite ready to let that baby out.

    I would rip the doc's throat out if they did something like that to me without asking, or warning me.
  4. by   valene
    another aspect: when a woman has adequate uterine activity for an adequate amount of time and does not progress with cervical dilitation, be suspicious of cephalic pelvic disproportion, or higher risk of shoulder dystocia.
  5. by   canoehead
    I HAVE nudged stubborn anterior lips up over the head so that a woman could push, and damn, that hurts too. You would think that during a ctx it couldn't get any worse, but it does. Usually they are already loose too.
  6. by   GYPSY-OB-RN
    I have never heard of a Doctor or a nurse manual dialating a pt's cervix. I have worked at numerous hospitals and in different states and this doesn't seem to be a common practice. I am shocked at the reply that one of the nurses posted that they would do this with the Doctor's consent. I was just curious to know if this is within the nurses scope of practice and if so what state they are working in?

    Please educate me!
  7. by   GYPSY-OB-RN
    Well, I guess some nurses are going to practice out of their scope of practice. It's seems to me that this practice is uncivilized and that if a little patience was exercised then dialation would occur on it's own and if it doesn't then there is a reason.
  8. by   rdhdnrs
    Labor is pretty uncivilized to begin with, don't you think
    I, too, have reduced an anterior lip, and just the other day worked with a doc who really reamed this girl out when stripping membranes. She had had a cryo but she was a G6P4 and he really wanted to save her from a c-sec. So I guess he helped the dilation out some and she did deliver w/o problems.
    Our "scope of practice" does include evaluating cervices and pushing patients when we feel it is appropriate. I don't see a problem with reducing a lip or helping a little tough place to stretch out if you're experienced enough to do that.
  9. by   canoehead
    Hey, I'm all for a natural birth, but if I say to a woman that there is just a little bit of lip in front that has been there for 30 min and if I nudge it a little I think it will move out of the way, but it'll ilkely hurt.

    They say yes, I do it and we are pushing. At times if the baby is right there she pushes the head right out. I've also respected the wishes of a laboring mum and tried positioning, relaxation (even more pit ugh!) and we have spent another hour working on that damn lip. Frustrating, especially if it is loose and keeps falling back down.

    So uncivilized is all from your point of view I think. But I am completely against doing anything to a woman without her and her partner understanding and consenting. Especially if it is going to hurt like a train wreck.
  10. by   GYPSY-OB-RN
    I think that I should have clarified my last reply. I work high-risk OB and do not see much natural child birth, but that is beside the point. My point being that there is a difference between reducing an anterior lip and ripping through a woman's cervix that is only 2-3 with scar tissue. Most nurses including myself have reduced anterior lips but I don't know if many would rip through scar tissue.
  11. by   canoehead
    No I haven't done anything with scar tissue, and wouldn't right now- at least not without more info. I would be concerned about the risk of bleeding.

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