The Cervix hunt

I have never performed that particular hand shake; however, we often talk with nurses who do exams on patients we fly. The exam is more of an art than science in many ways, and the findings are rather subjective from provider to provider. In addition, when I have to to OB rotations for clinical competency, the nurses I have talked with all say you literally need to perform hundreds of exams before you "get it."

Everybody's anatomy is different, and some cervices are *right there* and others you have to hunt for. Warm hands and going slowly do help.

Does your hospital have, for lack of a better way of putting it a 'vagina in a box' that you can practice on? (I've heard other, less polite terms too, but will stick with this one.) That helps too.

It is one of those things like starting an IV - the more you do it the better you'll get at it. I'm no expert here and there are others who will come along with better advice, I'm sure. But if you've only done 3, please don't beat yourself up! You're just starting out! It will come, and it might just click one day and no more worries.

If it makes you feel any better for the moment, everybody has had trouble, and sometimes even the docs (sometimes especially the docs) can't figure out what everything is in there.

I can try to help you, but are you talking about an L&D exam in term labor or a regular exam?

Elvish gave some great pointers! It's one of those things you will learn with job experience. I have small hands and short fingers so sometimes I have a hard time finding a posterior cervix that is -3 or higher. What helps me is turn a bedpan upside down and place a towel on top and place it under the woman's buttocks. It helps tremendously.

First don't stress it takes a LOT of checks before one gets it and then sometimes it is still hard. Start "practicing" if able on an epiduralized multip. They are usally not thinned out as much (at first) as a primip in labor. When you find it you will definitely have that "ah ha" moment. Also good idea about pt. that you feel are really posterior, have them sit on their fists or bedpan!

We do the bedpan trick a LOT with our pretermers.

Yep - takes time and POSTERIOR is usually where they are hiding. The bedpan trick is a good one.

steph

At the risk of sharing TMI - my CNM, who knows I'm an OB/Gyn nurse, kids me about my posterior cervix. "Ok, now it's gonna feel like I'm checking your tonsils...." It really does feel that way on a posterior.