New nurse ?- SVE's when closed/thick/high

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I am in my last week of orientation on L&D and am feeling pretty comfortable in most areas. The one area I'm concerned with however, is SVE's when the pt is cl/th/high. I've got short fingers, unfortunately, and there have been a number of times when I haven't been able to reach a woman's cervix because of this. I've had my preceptor there and she's been able to check behind me, but I'm really worried that once I'm off orientation and I get a newly admitted pt or an induction, I won't be able to reach her cervix. Does anyone have any suggestions? I've tried the fists under her hips, and sometimes can reach it then. I'm so scared I won't make it as an L&D nurse because of this. On a side note, once they're starting to dilate I usually have no problems finding their cervix and have been completely accurate in my assessment of their dilation etc, it's just the ladies where you feel like you're reaching for their tonsils that I have problems with. :)

Thanks for any advice!!

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This is not just a "new nurse" thing! I have very short fingers and sometimes I just can't find the darn thing even after all my "tricks". Sometimes it'll be anterior but because it's so high I'm trying to find it posteriorly & I'll miss it. Take your time, go slow & if you still can't find it, ask someone with longer fingers to check.:wink2:

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Specializes in L&D, Antepartum, Postpartum, MB, Special.

I am a new LD RN (1y) and I often get called in a room by experienced nurses because I have longer fingers. I used to think "you want the newbie to check someone" but I was always accurate and they trusted me.

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Specializes in L&D, High-risk AP, rural hosp..

Try a clean bedpan (not fracture pan), upside down with thicker part toward the feet and covered with a pad while pt totally flat in bed - it is awkward, but tilts the pelvis well. You can also carefully apply firm fundal pressure.

Alison, RN L&D

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It is hard to check someone who is way posterior. But, rest assured if you are having that much trouble reaching there cervix, they will not deliver any time soon!!

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Anytime I can't get to the cervix I do what gemininurse 71 does and I put my patient on the bedpan. I also lower the head of the bed so the head is flat or slightly lower. It really does make a difference.

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Specializes in Maternal - Child Health.

I don't mean to sound flip, but if a patient is so high/thick/closed that it is virtually impossible to assess the cervix, is a cervical check really all that necessary?

If a patient is that early in labor, why subject her to the discomfort and risk of infection of repeated lady partsl exams?

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I don't mean to sound flip, but if a patient is so high/thick/closed that it is virtually impossible to assess the cervix, is a cervical check really all that necessary?

If a patient is that early in labor, why subject her to the discomfort and risk of infection of repeated lady partsl exams?

Great advice~ :yeah:

steph

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Specializes in CCU, OB, Home Health.
I don't mean to sound flip, but if a patient is so high/thick/closed that it is virtually impossible to assess the cervix, is a cervical check really all that necessary?

If a patient is that early in labor, why subject her to the discomfort and risk of infection of repeated lady partsl exams?

I've had plenty of multips who dilated as much as 6 cm while their cervixes were still very high and at least 50% effaced. When a lady like that makes her move, she MOVES!

However, there are plenty of times when I'll document and tell the MD that the cervix is extremely high and posterior, and seems thick, but that I could not confirm dilation. If this is the case, then it's usually not worth the intense pain to the patient just to satisfy our curiosity.

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Specializes in nursery, L and D.

I am another short fingered one, lol. I always had luch with the pt on the fist and then slight fundal pressure.

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Our unit has way to many people that want to be electively induced, so many of our Docs will go along with them after 38 weeks. Lately it seems that many of our Docs are using Cytotec more and more, but many of them just start right on Pitocin. Our protocol is that before we start Pitocin that we check to see if the baby is head down. We are not supposed to start the Pit until confirmed, so we really have to try to access the cervix.

When I first started I asked the other labor nurses what am I suppossed to do I can't get to the cervix because it is to high. It is unspoken policy if the Dr. orders Pit we do Pit.

It is a surprise (sarcasm) that our unit has a extremely high section rate.

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Specializes in Maternal - Child Health.
Our unit has way to many people that want to be electively induced, so many of our Docs will go along with them after 38 weeks. Lately it seems that many of our Docs are using Cytotec more and more, but many of them just start right on Pitocin. Our protocol is that before we start Pitocin that we check to see if the baby is head down. We are not supposed to start the Pit until confirmed, so we really have to try to access the cervix.

When I first started I asked the other labor nurses what am I suppossed to do I can't get to the cervix because it is to high. It is unspoken policy if the Dr. orders Pit we do Pit.

It is a surprise (sarcasm) that our unit has a extremely high section rate.

Wouldn't a quick U/S give you the needed information?

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