Cervical Exam

LKB82 · Jan 16, 2007

I think I wrote a post almost identical to this several months back, and I completely understand your frustration. I don't think it's reasonable to expect you to "get it" after only two SVEs. Someone once told me it takes about 100 exams to really "get it", and a lot more exams after that to get really good. Are you working with a preceptor? Do you have a dilation practice tool on your unit? If not, I purchased a pocket dilation guide that I keep in my pocket, and it is helpful, (although I never use it in front of a patient). http://www.pocketdilationguide.com/ When I first started and was working with my preceptors, I would "practice" on people who already had epidurals beacuse I wasn't feeling rushed or causing them any discomfort while I was trying to figure it out. My preceptor would go first and tell me what she assessed her dilation, effacement, and station to be. Then I would try, and then I understood better beacuse I knew what 2 centimeters felt like versus 5 centimeters, and what 50% feels like and what 100% feels like, etc. After doing that a few times then I would perform an SVE first and my preceptor would check behind me to verify. I've been in Labor & Delivery for less than a year and I still go through slumps where my exams aren't perfect or I just want someone to check behind me. Overall, I do feel better about my exams but there is definitely room for improvement. :) But basically, I wouldn't panic over two exams yet.

SelectRN · Jan 16, 2007

I'm with you LBK82. I bought a Pocket Dilation Guide and found that it helps me alot. I use it all the time and even in front of patients. They love to see where they are in their progress. The thing that I found nice about it is that you can put your fingers through it so you can get a feel of what the cervix feels like on the outer edge of your fingers not like the charts or putting your fingers up against paper. There's even an effacement guide on the back.

NurseNora, BSN, RN · Jan 19, 2007

If you don't have a pocket dilation guide, remember that the monitor paper has a dark line every 3 cm (1 min on most monitors).

Other than that, just practice, practice, practice. Lots of good suggestions above. Be patient with yourself, if you alread knew all this stuff, you wouldn't need an orientation period.

JeanettePNP, MSN, RN, NP · Jan 19, 2007

I thought the current standard is to minimize internal exams during labor as much as possible to prevent infection.

Belinda-wales, RN · Jan 19, 2007

I thought that the reduction in internal exams had more to do with client privacy and dignity than to do with infection as it is only really a problem once the membranes have ruptured.

For the OP it takes time to get proficent, give yourself time and practise with it will come the experience you need- good luck

htrn · Jan 19, 2007

Minimizing cervical exams is important, but so is learning how to correctly assess cervical dialation. Pts at lower risk for developing an infection are good choices to 'practice' on. If a pt. is GBS +, premature or prolonged ROM, maternal fever, premature labor, etc... then I would definetly minimize exams.

We all had to learn somehow and I think allowing a new nurse to examine a patient after she has an epidural is a wonderful option. It takes time and practice - don't get discouraged.

Batman24 · Jan 19, 2007

How often are these exams done on a woman once she comes to the hospital?! Are they done once an hour or less/more depending on how dilated she is?! How many would be considered too many if the woman was healthy and not experiencing any problems?! When people are practicing does that mean they are still done only when necessary or are they done even when they aren't so the one training gets additonal practice?! Just curious as I am not yet a nurse nor have I had any children. L&D does fascinate me.

SmilingBluEyes · Jan 20, 2007

Doing too many cervical exams on women whose membranes are ruptured is contraindicated. There are plenty of opportunities to practice on all kinds of women, whether laboring or being ruled in/out for labor. But to check ruptured women over and over for practice is a really good way to start an infection in them. Not a good idea.

That said, practice makes perfect. No one learns this overnight. Be patient with yourself and give it time. You will get it after time and practice.

allnurses Guide · Jan 20, 2007

I thought that the reduction in internal exams had more to do with client privacy and dignity than to do with infection as it is only really a problem once the membranes have ruptured.
For the OP it takes time to get proficent, give yourself time and practise with it will come the experience you need- good luck

With my last child I went to the hospital with leaking amniotic fluid that was light green . . . and the RN said she couldn't check me for dilation due to infection possibilites. As I wasn't writhing around she figured, correctly, I wasn't dilated much . . . .but I begged her to check anyway and she said she would if I promised not to tell the doc. I was 2 cm.

We use iodine sprayed on a sterile glove after ROM . . . .except for the newer docs.

What about you?

steph

Belinda-wales, RN · Jan 20, 2007

As a midwife working within the uk I would not do a dig exam if I suspected rupture. I would how ever do a speculum examination.

If when looking at the cervix I felt that labour was established we would then do limited number of dig examinations. So the rule of thumb is no dig examination in rupture of membranes unless in established labour.

The reason for this that our term clients with ruputure of membranes who are well go home and wait for labour to start- at present they wait up to 24 for hours for labour to start.

I personally would not do a dig eaminaton on a client if I felt they were not in labour even if they beg me as it could put them and there unborn child at risk- any care I give I document that is how we practise in the uk.