dilitation/effacement. HELP!

Hi,

I've been a nurse for 8 years and have primarily worked in an office setting. I have alot of prenatal experience and I am a childbirth educator. 8 weeks ago I began working in the birthing center of my local hospital. It's a small hospital with about 350 deliveries per year. My question is about vaginal exams for cervical dilitation and effacement. I know a head when I feel one and I can feel sutures and fontanels but dilitation and effacement elude me. Will it get easier?

Also I read the thread about orientation lengths and mine is 12 weeks. Thats for L&D, PP, c-section recovery, and nursery. YIKES!

I will also be required to float to med-surg if our unit is slow. I'm nervous because I don't have hospital experienc but I'm so excited to be an OB nurse.

Cindy :)

[moonchild20002000]

Cindy,

It just takes time to feel comfortable doing vaginal exams.Do as many as you can. It will take time before you really feel comfortable.I hope you enjoy your time ib OB.Don't be afraid to ask questions and read all you can! Good luck!

[lgowan]

Cindy,

I made a similar post about a week ago. I am in the same scenario as you. My orientation lasted 6 weeks but I am feeling more comfortable everyday. These nurses have been a big help as well as the ones I work with. Go to my thread to see some responses. SVE'S Please Help! One nurse that I work with as well as some on the BB have said if the pt has had an epidural take advantage of it and do exams q30min-1hr. It also helps if you are fortunate to labor the pt through a lot of her progression so you can feel the difference.

One veteran L&D nurse asked me?! to check behind her the other night. She said it was because I had long fingers but I think she wants to help me build my confidence.

Good Luck! You'll do fine!

Lisa

[at your cervix]

I found early on in my SVE experience that the one thing that helped me the most was to measure my own fingers!! The index finger on my right hand (the hand I use for SVE's) is exactly 1 cm wide, therefore, if I can get one finger into the cervix, she is 1 cm, my two fingers side by side are almost 3 cm, therefore, if I can get two in side by side easily, with even a slight spread between them, the pt is 3 cm, two fingers side by side with a spread approx. enough that I could fit another finger between them is 4 cm and so on. Once the pt gets to about 7 cm, I feel how much cervix is left around the head!!! And, don't feel bad if someone disagrees with you, in my experience, I have found that between about 3-8 cm, you can get many people to check the same cervix and get many different opinions, but they will usually be within about 1-2 cm of each other. As long as you know that your pt is changing, or not changing, and you know when she is complete, the rest is usually just a rough estimate. Unless of course you get out your EKG calipers and put them in the cervix, then pull them out and measure the exact distance between them. (just kidding, please don't try this!!!) Good luck!!!

[kennedyj]

another trick I used as a reference is the fetal heart strip. Each red box is 1 cm, you can tear off a peice of an unused strip and measure your fingers on it.

If you can get it with in about 2cm and be able to tell if the cervix is dilating and progressing along with labor, and when she is complete you will be fine in the L&D setting.

A few months I was working in the ultrasound clinic and a term patient was having some conflicting stories. She said another hospital started to induce her because they thought she was ruptured and then sent her home several hours later. We went to the L&D unit and they were very busy so I did an SROM speculum check. She was a neg ferning, neg nitrazine, but had moderate thick mucous pooling near the cervix, and no gushing w/ kegal and was 3 cm dilated. I wrote a note that she was intact and left for the OB/gyn to follow and Discharge. The next day I saw she had delivered on the mother/baby unit. I worried that maybe she was ruptured and maybe the mucous was amnio fluid and I had missed it. I asked her and she told me that her AFI was low and she was induced for that reason.

sorry for rambling.

Jared

[puzzler]

All the above posts are great info and I think I used most of these same tricks. It is really helpful to have someone check the patient at the same time so you can compare. Of course this should be someone that you know is good at exams. I have worked with some doctors that are so far off it is not even funny.

I did L&D for 12 years and loved every minute. I am sure you will do fine. It just takes time before you will feel comfortable.

Good luck

[valene]

please be careful of excessive exams, if the patient has premature rupture of membranes or has group b strep, exams can introduce infection.