cervical checks, again

You are doing just fine...I think one of the hardest things to teach people is to find the cervix, because during labor the cervix will be "floppy". Remember the cervix changes in three ways: it opens or dilates, it thins or effaces, but it has to soften first in order to open and thin.

Once you find the cervix gently insert your finger/s into the opening and then gently stretch them apart...that is how you determine dilation. The next tricky part is to learn to relate how it feels inside to a number.

It takes time and lots of practice so I think you're doing great if you "find" the cervix after only 4 exams!

That "floppy" feeling is most often a multip cervix. If the pt. is term I insert fingers, spread them gently to ascertain dilation, sometimes slightly rotate fingers to get a better "feel" while also assessing presenting part and position. If the pt. is preterm and I've been asked to check her, I simply insert my fingers until I feel the stretchy cervix slightly, then report it as, for ex: about 3 cm, soft and stretchy. If it's already like this, stretching could stimulate further dilation.

Just keep on checking. After so many, you will check one and finally figure out what all the fuss was over. You really do have to check many many many before you feel comfy with exams.

My advice....when you have a primip who "thinks she might me in labor" and "is not sure if I am having contractions or not" when you can't find the cervix....keep going. It is located somewhere near the tonsil area:)

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Using a chart very similar to this is how I learned. Also, there is a little trick where you can use your fetal monitor paper as a guide. (1 minute of paper = 3 cm)

My advice....when you have a primip who "thinks she might me in labor" and "is not sure if I am having contractions or not" when you can't find the cervix....keep going. It is located somewhere near the tonsil area:)

:rotfl: :rotfl: :rotfl:

Using a chart very similar to this is how I learned. Also, there is a little trick where you can use your fetal monitor paper as a guide. (1 minute of paper = 3 cm)

My favorite trick was to be sure to spread the fingers on the hand you are not checking with to the same distance of the internal fingers.

Go ahead and try it now with your eyes closed. I bet you can get almost exactly the same spread of fingers on both hands without even trying hard.

This is also good when your fingers have to change shape on the way out. It may be hard to replicate what you were feeling once you pull back.

Go ahead and try it now with your eyes closed. I bet you can get almost exactly the same spread of fingers on both hands without even trying hard.

I'm sitting here at my computer with my eyes closed spreading my fingers then looking to see the differences/similarities and DH walks around the corner...all I heard is "do I even want to know what you're doing?"...when I opened my eyes he wasn't even standing there any more :lol2::lol2:

RNin'08

~my reality check bounced~

Do nurses do internal exams? I thought only doctors and midwifes do it...

to gw489...

at some teaching hospitals where there are residents 24/7 the nurses do not do SVEs

at private facilities where the MD is at home asleep.....or in the office seeing patients the nurse does EVERYTHING....

vag exams

inserting internal monitors

and my favorite order "nurse may start pitocin PRN at nurses discretion"

90% of the time the first time the patient sees the doc is when she is crowning....

the only thing we are not allowed to do is break water(although we can place a scalp if the baby is having a decel.....or if we have difficulty tracing the baby therefor breaking the water) and do a C/S....although we are able to transfer patient to the OR and prep while the doc in en route....

Thanks for the advice guys. It finally "clicked" with me yesterday, and although I have a long, long way to go to feel comfy, I actually found the os, and guesstimated, and was right on with what the resident said she was when she checked her about 10 minutes later! I'm sure my family is tired of talking about cervix's, lol, but I was so nervous about it and worried that I would never feel anything but mush. Thanks again everyone!

when you have a primip who "thinks she might me in labor" and "is not sure if I am having contractions or not" when you can't find the cervix....keep going. It is located somewhere near the tonsil area

LOL... yep, when I started this was my next challenge just after I figured out the mush....

When I first felt the mush, I was like "whoa" ... I was prepared to figure out the centimeters but had no idea they got that way & I'd have learn to distinguish it from the rest of the mush before I could even measure :) ... but I figured that out way faster than the 'up in China', closed cervix.