Inconsistencies in SVEs

[LNDNursila]

Hello there! I'm a fairly new RN, 14 months as an LND RN. I wanted some advice on how to tackle this situation that happened to me this morning during shift change.

Last night I had an induction for GHTN. When I checked her upon admission, she was 0 cm. After a dose of cytotec, she was 2cm and after the epidural I called her 3 cm. For me, 3 cm is being able to get 2 fingers into the cervix and spread them slightly.

Fast forward to shift change! The provider wants to go AROM the pt. When she checks her she tells the dayshift RN that she is 1.5cm/tight 2 cm and won't AROM her.

I was literally shocked. I know that vag exams are subjective but for me 1.5 cm means that you can't get a second finger into the cervix and I very well could. I can't help but feel slightly incompetent and embarrassed but I still feel like she was 3 cm in my opinion! I haven't been able to stop thinking about it. I've seen times before where doctors and even other nurses backtrack exams because they don't agree with the previous checker but I haven't had it personally happen to me. Does anyone have any advice or personal experience with this type of situation and how to navigate it going forward?

[amoLucia]

TY. Was just thinking what might have caused a true difference to OPs situational issue. That's why I asked my question - I mean muscles are contractile.

Inquiring minds wanted to know.

[KTMendonca, MSN]

Checking during a contraction vs. in a relaxed state can affect the SVE as well. 

You have to get to know your docs. Some are universally generous with their exams. It pisses the patient off for you to call her 3 and the doc come in a minute later to call her 5. With those docs, I tend to be very conservative and chart to the lesser of the degree of cervical change. In other words, if they could be a "stretch to 4", I will call them three. If the provider checks after me, WOW! they are making progress. LOL. Conservative checks rarely piss the doc off. Generous ones do. 

With nurses with less experience, I also see them evaluating outer rather than inner OS. That can throw off your check significantly. Make sure you go all the way through and assess the opening closest to baby's head.