Vag exams

  1. I am new to this board but look forward to becoming an active member of it.

    I work in a very busy LDRP and I am having trouble with performing vaginal exams. I am absolutely clueless and have no idea what I am doing in this area.

    I go in with my two fingers and feel mush. I haven't ever even felt the cervix. Besides practice making perfect, any more suggestions?

    Thanks
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  2. 13 Comments

  3. by   bagladyrn
    If all you are feeling is "mush", you're not reaching far enough. Also, kind of angle your fingers toward the back more as the cervix is most likely posterior early in labor. Do you have some one precepting you on this? If not, ask one of the more experienced staff to let you check behind her when she finds someone with an easy cervix to feel. I've found that women who are multips are easier to approach about this when asking their permission for teaching purposes.
  4. by   SmilingBluEyes
    go in, reaching toward the small of the woman's back..... by that I mean, when you go in, move your examining hand ina curving motion, toward the small of the back----the cervix can be VERY posterior and this is the best way to find it....also.....

    have her head as low (trendelenburg's position) or put a bedpan under her buttocks before examining her. This will make your reach easier, believe me. gently have your nonexamining hand on her fundus, don't exert real pressure, just gently pushing down the fundus to further bring the baby (and presenting part) toward your exam hand. Keep on going up and back til you feel it----trust me you will.

    With practice, you will get this SOON. I remember asking my preceptor, "what am I supposed to feel here" And she said:

    "A HOLE!!!"

    I felt so stupid, but when my fingers litererally fell into the cervical os, it WAS an "OH WOW" moment for me. Give it time, you will be a pro in quick order with enough practice!
  5. by   MidniteLaborRN
    Thank you very much for taking the time to share your wisdom and expertise with me--I appreciate it--as will the residents and patients that I work with . Please... gimme more.
  6. by   SmilingBluEyes
    ask.

    i am an open book.
  7. by   puggy
    Many years ago a physcian sat with me at night in labor hall until I could learn the ins and outs. He kept telling me to either feel for a hole that my fingers would slip into, or a stretch rubberband that I could run my fingers around. Hurray! One night my index finger slipped into a hole. Congratulating me he said he wanted to check to see if the baby was vertex, he did a quick vag exam, and busted out laughing. The cervix was 5cm, the baby's rectum was 1cm!!!! Hang in there, you'll get it.
  8. by   webbiedebbie
    When I was new, I did the vag exam and felt something curl around my fingers!!!!!Freaked me out at first! The baby's hand was down (was a breech). I will never forget that!:chuckle
  9. by   SmilingBluEyes
    yea you never forget the first time a finger is either sucked or slips into a rectum.

    it happens to us all eventually.
  10. by   RMH
    Practice, practice, practice. And practise consecative exams, to feel changes. Patients with epidurals are the best...I've given people examples of what different cervixes feel like. ie. a role of tape is 2-3 cms, thick. A small rubber band is 5-6, 80%, soft. Ask someone for help like that. Remember everyones exams are a little different, hence the reason for consecative exams to tell progression. Good luck
  11. by   renerian
    Puggy I am laughing very hard!!!!!!! You made my day!

    renerian
  12. by   judy ann
    Lordy, I guess I really am old. When I started in this business, we checked cervical dilation via rectal examination, feeling the cervix through the rectal vaginal wall. Talk about a challenge!!!
  13. by   SmilingBluEyes
    talk about HORRIBLE for the moms. I can't imagine that.
  14. by   sbic56
    It's usually the case when learning that the exam is not performed deep enough into the canal. Best to get all the way back and come forward. Having the patient put their fists under the small of the back is really helpful if they can do that, too. Anything to tip the pelvis up a bit.

    I can remember a midwife told me to randomly check circular objects with my fingertips and estimate the dilitation when I could see my fingers to get the dilation correct when actually performing the exam. Good tip, I thought.

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