Calling L&D Nurses - Tips and Tricks?

For lady partsl exams - if you think your in far enough, go in more. Learn spinning babies and implement early on in labor - if possible, ask the provider what they think baby's position is so this can guide your positions etc.

If the cervix is still very posterior, I have found that a bedpan, covered with a chux and placed up-side-down with the higher part at the lower back and lower part under the buttocks, helps tilt the pelvis enough to make getting to the cervix alot easier. Also light pressure at the top of the fundus can help.

Hi, I'm a new grad in L&D (8 months in) so here's some tips from my perspective:

For SVE's...crawling the fingers helps, if it's very posterior you can have them pull their legs back (pushing position) to bring it forward. Tips like fist in the back or bedpan have never worked well for me. I typically try to sweep my fingers in a circular motion til I feel something I can "hook" and then I can either put my second finger right there or have to sweep it along the edge til I feel the other side (when they are 7-9cm). And I've found it's easier for me to find the cervix if I sit on the edge of the bed vs stand over them. It's also helpful to take a deep breath and relax if you are not finding the cervix right away, and ask the pt to do the same! It's so uncomfortable but is easier when they relax their muscles and breathe. And don't be afraid to ask someone to check after you if you're unsure! I'm flat out with the patient and say things like "I just cannot find your cervix, sometimes I can't reach far enough back so I'm going to have xyz come check" or "I am going to have xyz check you because I don't think I feel any cervix, I just want to be sure before we start any pushing". Because sometimes the way baby's head is squished makes me think hmm, is that a lip of cervix? So I grab an experienced nurse I can trust to tell me one way or the other.

For calling the dr, this is something that takes practice! But you can tell when they are moving the baby and when their pushes are just not effective yet. Typically once I can tell baby is moving, I take my fingers out for the 3rd push of the contraction to see what is happening without my help. If I can see about 1/2" of head and the Labia are bulging, I call for the dr. Obviously, I call sooner if it's a natural pt because they can't just let a contraction or two go by before the dr comes into the room. Typically it's a couple more pushes when the dr gets there before I call for nursery (they catch our babies) but sometimes I call at the same time as the dr, just depends on how well the momma is pushing! It will come with practice. I'm still trying to perfect my timing with it all and not second guess myself! I haven't been totally off base yet but I still don't 100% trust myself I guess. I always call the dr before nursery, or them both at the same time. Never nursery before dr. I'm saying that because you ask about calling the charge nurse, we don't do that for ours so I'm wondering if your charge is your baby catcher and you're asking who we call first...of course, all this assumes the dr is in house. If that's not the case, I'd call before doing any practice pushing at all just to communicate a timeline.

The first bunch of cervical checks I did were not cervical checks. They were me with my fingers in a lady parts, afraid to go in further, and feeling nothing of clinical relevance. Finally, an experienced nurse told me to slide along the bottom of the lady parts (posterior if the patient is supine) and go in really far, then start "looking" with my fingers. The cervix is often much further back than you might imagine. Walking is for when you are already far enough in, but the cervix is too posterior to reach without a little help. Walking won't help if you aren't in the right vicinity.

In early labor, I always have the mother put her fists under the small of her back and use light fundal pressure. Once I figured out what I was doing, it was a breeze after that. In five years of L&D, there is only one cervix that I absolutely could not reach for assessment after figuring out what I was doing. I have short fingers, so I simply couldn't reach. That patient was a prime at 37.1. Even though I couldn't feel her cervix, the clinical picture told me that her cervix was very posterior because she was just not in labor. I told the physician this and he said we needed to know for sure, so I asked him to check her. It was a painful 10 minute process, after which he declared her very posterior and closed.

Practice on a cervical measurement board to get the hang of those middle of the road measurements, 5-8cm or so. You will get it with experience, same with knowing when to call the doc and peds team. Even the best of us get surprised once in a while though.