cervical exams?

P_RN, ADN, RN · Mar 23, 2011

Only cervical exams I know about are in the neck, my being an ortho nurse and all. Have you asked your nurse educator or preceptor for hints? If not you should.

NurseSassyPants · Mar 24, 2011

I'd say it took at least a dozen tries, with an experienced RN checking behind me before I felt really comfortable. Here are some tips.

Dilation-draw circles or use anything circular that you can stick your fingers in. Measure afterward to check yourself. Effacement-a thick cervix is about an inch, or on me, the top portion of my finger. Halfway to the line that would be 50%, 1/4 is 75%. Station-feel around the sides of the cervix for the ischial spines. This is also easier with practice. Ask your preceptor or charge nurse to let you do all SVEs when possible.

klone, MSN, RN · Mar 24, 2011

For me it was a good few months. I remember the nurse I was working with said "Just take your time and feel around in there" (the woman was heavily epiduralized and gave her permission). I remember having the "a ha!" moment when I *got* it.

BrookeeLou_RN · Mar 24, 2011

Make your self a practice board, with different centimeters...Practice using your hand and seeing how each size feels, then practice on other objects like small pancakes, pizza, etc. Till you get everything you see with your eyes as a measurement in your head. I find it helps to close your eyes and visualize what you are feeling. Effacement .. you need to just know what the different percentages feel like and keep that in your mind..

Once it is in your head.. it will be there forever. I have not done a labor check for 19 yrs and yet I can look at a wound and know the measurements before measuring..

klone, MSN, RN · Mar 24, 2011

I'm guessing from the OP's post, that her problem isn't so much figuring out the different dilatations, but rather just figuring out what exactly she's feeling in there. She said everything just feels like mush. I remember feeling that way at first. You need to really understand what a cervical os feels like before you can start differentiating dilatation. Once you KNOW what the cervix feels like, the rest comes a lot easier. Find a willing patient who has a nice epidural, and just take your time with exam and really feel around in there for landmarks. Once you figure THAT out, the rest will come.

freedom4 · Apr 3, 2011

I am a very visual learner, and I just couldn't get cervical exams. Then one time I was at the nurses station and someone had brought out a model of a female parts complete with cervix and interchangable stages of dialation. That is all it took. Once I seen what I was looking for I was able to find the cervix. See if you department has one of these. It really makes sense once you see it. :yeah:

tewdles, RN · Apr 3, 2011

Remember that in nursing it takes about 6 months before you feel like you are not an idiot...SVEs would fall into that category. Just keep practicing while keeping in mind that the epidural patient is your best educational model...SVEs are not comfortable for the actively laboring patient opting to use little analgesic.

You will get it...good luck!

Tahoewed777 · Apr 8, 2011

I am so glad that I am not the only one feeling this way. I have been a nurse for about 7 months and started in L&D about 6 weeks ago. I have checked approximately 8-9 women and have yet to figure out what I am feeling. It completely feels like mush to me too. No one can seem to explain exactly what a cervix feels like or how to distinguish it from the rest of the mush. We don't have a practice pelvis to use...I wish we did. Another problem I seem to be having is I just don't feel like I know how to get my hand in there so that it will actually reach......if I am lucky enough to find the presenting part with my fingertips I then am unable to move my fingers around much feeling for the cervix. Everyone keeps telling me I will get it but I am afraid that I won't. I really can't wait for the A-Ha moment.

bagladyrn, RN · Apr 8, 2011

If what you are feeling is "mush" then it is likely that you are not reaching far enough. The cervix is generally somewhat firmer than the surrounding tissue and the fetal head is hard.

Try tipping the patient up - either have her place her fists under her buttocks or use a fracture bedpan upside down with the narrow end toward the head of the bed under her buttocks. This will have the effect of tipping the cervix forward. Then run your fingers up the back of the lady parts and then move them forward until you find the cervix.

JenTheRN · Apr 8, 2011

Finding a cervix is like finding a rubber band in a bowl of jello. It's there, it always is, but you have to know what you are going to encounter. I also think of the cervix like a turtleneck sweater. When one is not in labor the cervix is long and thick like the neck before you put it on. When labor starts it starts to put pressure on the neck ie, like when you put it on your head and pull it over.

That being said it just takes time. And practice. Lots and lots of practice. I still have some cervixes (is that a word?) that baffle me. I also have been blessed with short stubby hands. Not the easiest for finding a cervix. But if I cannot reach one I still have one of my coworkers check. One good thing to know, if a cervix is so high up and posterior that it cannot be reached, it usually means the woman is not in labor.

There are a lot of tips out there on checking cervixes, no pun intended. Have the patient as flat as she can tolerate. Have her put her fists underneath her pelvic bones and tell her to do a little "pelvic thrust". Also telling her to take a deep breath and blow out helps to relax the pelvic muscles if she is fighting you.

Tahoewed777 · Apr 9, 2011

I found it!!! It was such a perfect tunnel....felt just like I thought it would. I think I accidentally found it though because when I tried to find it a couple of hours later I couldn't. My coworkers think that I didn't find it again because I was being to "kind" and not reaching in enough....but like I said in my other post I feel like I have pushed my fingers in as far as they will go. But I'm not giving up!