Cervical Checks

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Good morning...I am a new grad. RN working in L&D. I am having a hard time doing vag. exams & checking cervical dilatation. Does it get any easier? Are there any tricks? Thanks for your input!

Stephanie

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

it does get easier. With lots of practice. Don't sweat it, you will learn as you go........

can you be specific on what troubles you? I might have a good hint for ya!

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Finding the cervix & assessing dilatation...I have my preceptor check first & then she guides me to where the cervix is. I guess I just feel like I'll never get it. She keeps telling me it will click one day & I'll know for sure on my own. I sure hope so!!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Ok this is what I have done since I entered OB nursing in 1997:

First, I prepare the patient and get her PERMISSION to check her before I even touch her. If you are not well-versed, this is a good time to practice Leopold's manuevers. I do this on every patient, first, and tell her which way I feel the baby is facing. Most enjoy hearing it, and it breaks the ice. Also, it's a valuable way to assess fetal position that is not invasive.

Very important------it's her right to give permission to touch her, and you will have much more cooperation and relaxation when you do.

I then ask her to relax her legs and put her head in lowest position of bed possible. I also ask her to place her hands at the small of her back as this elevates her pelvis, making a high, posterior cervix easier to reach. I try to have warm hands when I do this too---does make a difference. I wait til she is ready---I never nudge her legs apart or anything of the sort. I wait til she does so-----it relaxes her and makes, again, a high and posterior cervix easier to reach.

I then take my well-lubricated, gloved hand (warning her it will be a bit cold and wet) and in slowly following the natural curve of the small of her back----I follow the posterior wall of her lady parts, to find the cervix. This is the BEST way to reach a very posterior cervix, or an os that is behind a low-lying fetal head/presenting part.

I then do a gentle sweep from posterior to anterior til I find her cervix, and once I do, spread my index and middle fingers gently, finding all borders of the cervix to assess dilatation. Doing this, you will also be able to assess effacement, which is trickier.

Remember: a completely effaced cervix feels like paper or a delicate barely-there membrane, 80% like a rubber band and less than 50% is non-soft and thicker. A 0% (uneffaced) cervix is 1 inch approximately in length. Personally I dont' get hung up and play w/any numbers other than those. Really, there is not much diff between say, 70-80% ----I mostly chart 0, 50, 80, 90 or 100%. I am amazed at folks who can call a "30% effacement" but hey, we are all different.

Remember this: you can use the monitor paper as a quick, readily available guide to dilatation. Each bold block (1 minute of time) is 3 cm!!!!!! Put your fingers to that and you will quickly be able to estimate how dilated a patient is w/o one of those hard-to-find cervical dilation charts.

Be SURE to report your findings to the patient----it's important she get feedback as it is HER situation and body you are assessing. You would be amazed how many are checked in the dr office and never TOLD HOW DILATED THEY ARE!!!!!

If you are at all unsure (and after 9 years I still am at times) get a 2nd nurse to assess behind you. Do not be afraid to tell the patient that cervical assessment is an objective one---that opinions may differ and just cause you call her a "5" and a dr says "3" does NOT mean she went "backward" in progress. It's simply the difference in size of fingers and opinions!!!

Does this help?

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That was very helpful!!! Thank you so much. Before I was going anterior then trying to go posterior, but I understand now how going posterior first will help a lot! Thanks again!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

You are more than welcome. Let me know if these tips do help you.

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Specializes in OB, lactation.

Deb, I know you wrote it for Steph but thanks from me too!! :D

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Thank you, certainly a compliment from you!!!!!!

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The way that was most helpful for me to learn to check dilatation was to measure everything in the house that was round and had some type of rim. I also carried a tape measure and assessed how accurate I was when measuring household items. Some things that you could practice on: a coke can, can of soup, toilet paper roll, mouth of a glass. Don't despair, it comes with time and one day you will just "fall into the cervix" and say ah-ha!!!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

also long sleeves seem to work, for some.

Truly it just takes a lot of practice, there is no "fast track" to learning some skills.

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That was very helpful!!! Thank you so much. Before I was going anterior then trying to go posterior, but I understand now how going posterior first will help a lot! Thanks again!

I'm a new grad on L&D, too, and am having this SAME problem. I think I was doing the same thing as you, Steph.

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Specializes in L/D, Peds.

Cervical exams are definatly an acquirred skill. It takes time. Just keep checking and it never hurts to have someone check after you to be sure. Even experienced nurse do this sometimes

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