Help with SVE's

Part of the problem I used to have with this was not getting posterior enough. Sometimes, especially fingertip-4cm you have to really go for the tonsils!!! Don't be afraid to get the tissue with your fingertips and "walk" it toward you so you can get in that cervix. The hardest part is that this can be quite uncomfortable for the patient, but it has to be done, so have to try to get over that. (I hope that didn't sound callous!)

Good luck. You're right down the road from me, I work in Little Rock. Feel free to email me personally if you want to talk.

Hi Shannon,

I don't know if you finished your program yet, but you could talk to the person handling your training program and see what the unit has to train with. We have those plastic dilation models in each room so that if you are ever unsure about an exam you can double check (they can be photocopied and kept in your pocket as well). We also did a skills day in our training program and practiced ve's with boxes that had rubber heads, cervix, etc.

Do as many as you can, triage can be a good opportunity for practicing early ve's.

The advice about walking your fingers to the cervix is good. Also for a posterior cervix you can try lowering the head of the bed all the way and having her put her fists under her hips.

Also could try feeling circular objects around the house and trying to guess the diameter without looking.

Hang in there.

BTW Congrats to you and family.

i once had a young, primip push for an hour, when the doctor came in , he checked her and laughed. he called me out of the room and informed me that she was only 5 cm. he told me to recheck and reach extremely posterior, when i did, i felt the plain as day 5cm cervix, talk about embarrassing. especially since the poor girl was now completely exhausted. after that, i've always reached as posterior as possible before declaring anyone complete

Wow.

Was her cervix swollen as a result?

gee, i cant remember, its been so long ago

We have a lot of posterior patients, but the ones that get me are the people with a tunnel cervix in which the inner and outer os might be different. Also, I cannot say I have ever felt the spines, which is something our OB chief says should be done with each exam..

Another tip for those posterior people is to be aware that the people with back labor and bigeminal contraction tracings on the monitor, are the ones you are going to have to dig for. Placing your free hand on the top of the abdomen and gently pushing the baby toward you at the time of the exam, also helps..

An old seasoned nurse once told me that if you ever feel a gossamer cervix, the patient is going to deliver quickly. I thought, what the hell is that, until I felt one. Thats the thin thin threadlike cervix..

Even now seasoned nurses like myself, have been known to occasionally (VERY occasionally :) ) miss an exam because it feels fully and may really be a posterior dimple...Sometimes it just feels like mush, as you said...

The thing I run into is some problems locating the urethra on pregant patients when we put foleys in...In my olden days as a cardiac nurse, we used to call the maternity people to put in our foleys because they had seen everything...But, I digress....

Pucker your lips up and feel the ridges--this may get you more comfortable with what a closed cervix feels like--it may seem like mush, but if you really move slowly over your lips you will notice that there are borders you can identify.

Once dilation begins you should be able toinsert a finger or fingers into the os.

Also, women who have had procedures like cone biopsies or cryosurgery on ther cervixes break all the rules. It's always helpful to know if women have had these procedures--their cervixes may feel knotted, deformed and hard. If they're laboring, they bear very close monitoring--their cervix may stay that way until the scar tissue breaks apart--never a good idea to throw these ladies out the door after 1 hour with regular contractions--you'll almost guarantee them a delivery at their nearest Exxon.............

Angel baby, I had NO idea! (really)... And all this time I have been using the turtle neck example.....Thanks for the info!More material garninshed from you to add to my delivery routine! :)

The one thing that I found that helps most with finding a posterior cervix is to have the pt tilt her hips upward, it brings the cervix around and it is MUCH easier to find.

First, early cervical dilitation may mean that the OS of the cervix is posterior, so without finding it, the cervix feels like "mush". Pull the cervix toward you with one finger, use the second finger to feel the back of the cervix. This may require an estimation of dilation. And of course, this is painful to your patient. Have the patient use labor breathing techniques for cervical exams.

Second, use a dilitation chart and get used to how a three centimeter cervix feels to you. It is personally my two fingers side by side, using that as a basis helps me determine a 1cm (can't even get one finger in), 2cm (one finger in with a little extra room, or two in fingers atop each other, not side by side), and 4cm (two fingers spread apart easily). Always keep in mine things like cryo and biopsies of the cervix. It always helps to check a cervix during a contraction if you find it difficult to get to the os. But remember, women without an epidural AND having a contraction are the hardest to check.

Hope it helps

From the voice of experience here: ALWAYS check fetal position when you think you "feel cervix". We have had numerous FT to 1cm noted by new nurses who were in fact frank breech!! Think about it, this happens quite often. Also, I agree, until you are comfortalbe with SVE's you should not hesitate to have a back up examiner to give confidence when there is a question. The more you do the better you will be.

If we want to delve deeper into other things beside just simple cervical dilation, we have to also think about such things as vag. bleeding...don't check the cervix until an U/S rules out a previa. You don't want to punch a hole right thru the placenta. About fetal position, this is true...especially if the cervix feels "weird" to you. Many "weird" cervixes can be malpresentation as well as cryo, etc...Our hospital policy is the presentation is noted along with dilitation/effacement/and station.