Cervical exams

JaneyW · Mar 19, 2005

HI, I am a fairly new (8mths) nurse to ob. On our unit we rotate between postpartum, labor-delivery, and nursery. I recently came out of orientation and have mostly been assigned to nursery, rarely getting to do labor. I finally got the chance to do labor this past week and I am not feeling very confident on cervical checks. I can tell you what 1cm and 9.5-10cm is without any problem. Anything between this is questionable to me. Of course we have the cervical dilation charts on the doors in the rooms, but, I can't always remember how far my fingers were spread during the exam. Also effacement, how on earth is that figured out??? The nurses on the unit just say it comes with experience, but how can I get the experience without knowing what I am feeling for? So on to station. I can tell if a baby is up in egypt or really low in the pelvis, however not at a -5 or +2 station. Does anyone have any tips or tricks to give me??? Please help!!!

First of all, you need to do as many exams as you can--not just every now and then. I have been doing L&D for about 2 years and I can remember what it was like before it kind of clicked for me. I still have doubts sometimes and ask for a second check from a co-worker. Even the very experienced ladies on my unit do that--we are none of us perfect.

Have you felt many closed/thick/high? Once you have felt some VERY thick cervices, it is easier to know what the differences feel like. Station comes from the pubic bone. Use that as your zero guide and go plus and minus from there. As far as dilation, sometimes it gets kind of tricky between 5 and 8. Especially with multips with buldging bags. The nurse who originally precepted me helped me a lot by having me do it backwards. How much cervix is left and subtract from 10. Do you still feel 2-3cms on each side? etc.

Basically, we all have our own way and each person's exam is going to be slightly different. We have one MD who will tell people they're 2-3 and they come in with the slightest little bit of pain and their outer oss is 2-3 but they are really closed and end up getting sent home. I can't tell you how many drawings I have done explaining effacement and dilation to my patients who swear up and down that they HAVE to be 3 because the MD said so.

Hang in there--you will get it, but you need more practice.

babyktchr, BSN, RN · Mar 19, 2005

It really does come down to practice. And just resign yourself that it is gonna take some time before you will be comfy. I have checked cervix's for over 10 years now and there are times I am like...what the heck am I feeling???

One little trick for you....since your monitor is usually close by...remember that 1 minute on the monitor strip is 3cms....sometimes you can act real nonchalant and mosey over to the monitor to write on it and put your fingers to the paper and measure that way.

I know when I was orienting...they had me check everything that came thru the door. Perhaps you can talk to whomever is working with you for the shift and ask if you can be "exam" nurse for the day or night.

USA987, MSN, RN, NP · Mar 20, 2005

One little trick for you....since your monitor is usually close by...remember that 1 minute on the monitor strip is 3cms....sometimes you can act real nonchalant and mosey over to the monitor to write on it and put your fingers to the paper and measure that way.QUOTE]
What an awesome idea. I wish someone would have taught me that when I started L&D!!!!

Pixie Dust · Mar 21, 2005

There is a helpful little guide out there called the Pocket Dilation Guide (pocketdilationguide.com) that was developed by an L&D nurse. It's great. You can keep it right in your pocket so its there when you need it and you can place your fingers inside the centimeter circles so it feels very similar to the real thing. It also has effacement measurments on the back of it. Check it out. I've been doing L&D for 10 years and I still use it. Remember, we were all new at this once, it just takes time.

SmilingBluEyes · Mar 21, 2005

i was taught the monitor strip trick, too. and it's a GREAT tip!

babyktchr, BSN, RN · Mar 21, 2005

I don't know about the docs or midwives you work with, but the ones in our group are very accomodating. When I first started, they got dilation, thick or thin and high or low. As I got more experience, I offered more details. That at least gives them an idea of what is going on.

If you take a piece of paper...and put it on a table or counter....feel the difference when you move your finger over the paper...from the paper to the counter. That is pretty much what a 100% effacement feels like. Sometimes they are so thin, you can hardly feel the cervix.

I laugh sometimes at docs who announce a 65% effacement...or 1 3/4 cm dilation. I mean...do they have a ruler??????

FrumDoula · Mar 24, 2005

In my doula bag, I have a dilation chart made of soft foam. One piece of foam with a circle cut for centimeters 1-10. It's slightly stretchy, which is a lot more accurate than those stupid plastic charts the ladies are so often shown in their childbirth ed classes.

As my client progresses, if she's checked, I'll show her where she's at. I also use the chart as an indicator of how subjective the measurements can be.

As for those docs that can measure 2 3/4 cm, good heavens!!!! How full of themselves can they possibly be?!?!?! (And it leads me to wonder, if it's a man, what he tells the ladies he's intimate with about his .... ahem ... endowment! :) )

I also remind my clients that sometimes dilation means nothing. We're all familiar with the 4 cm. "transition". And how you can have someone who goes from 3-10 quickly, but the lady in the next room decides to park at 8 cm. for hours and hours. Those numbers are only good to a point.

Penny Simkin, childbirth educator and doula extraordinaire, likes to predict the vag exam results by watching emotional signposts instead. She finds herself to be fairly accurate.

And once that mama's water is broken, it's not like you want to stick your fingers in there that often anyway ... it really raises your chances for infection. ick!

Alison

SmilingBluEyes · Mar 24, 2005

I practice observation to assess labor progress MUCH more than dilatation. I limit my cervical exams as much as possible, instead watching for subtle changes in mom and baby's heart-rate. More often than not, I do NOT need to check a cervix to know when a lady is progressing quickly or is nearly dilated. Even with an epidural, I can see it already in the behavior of mom and the fetal responses and act accordingly. I think most experienced labor nurses can say that same; I am surely NOT unique.

JaneyW · Mar 24, 2005

I practice observation to assess labor progress MUCH more than dilatation. I limit my cervical exams as much as possible, instead watching for subtle changes in mom and baby's heart-rate. More often than not, I do NOT need to check a cervix to know when a lady is progressing quickly or is nearly dilated. Even with an epidural, I can see it already in the behavior of mom and the fetal responses and act accordingly. I think most experienced labor nurses can say that same; I am surely NOT unique.

I agree! I am not even that experienced yet and I do the same. There is also some emotional benefit to not checking too often--more progress made with each check! I think as nurses we can see that 'look in the eye' of those progressing rapidly. It isn't 100% accurate, but more often than not.

SmilingBluEyes · Mar 24, 2005

............not to mention the infection factor. Remember, you have statistically roughly 6 checks in a post ROM woman before the chances of infection rise SIGNIFICANTLY, so it does pay to limit lady partsl exams to BARE MINIMUM!

camay1221_RN · Mar 24, 2005

My preceptor is also a minimalist when it comes to SVE's. Besides, we have enough residents in the place who check frequently enough, that I rarely have to.