New Nurse - help with cervical exam

  1. So I am a new grad L&D nurse and I have been working on the floor for about a year. At our hospital the physicians and midwives are usually the ones checking the cervix, so I have had very very limited experience with this. Every once in a while when I do get to check, I feel so lost. Sometimes I worry that I am reaching too far back and am not feeling the right thing. I know this is silly, but whenever I check it just feels like a lot of "mush" down there and I don't know what is cervix vs vaginal tissue. Can anyone explain what I am supposed to be feeling for? How can I be certain I have found the cervix? Is it possible I am not reaching back far enough, even though sometimes I feel like I can't possibly get my hand any further? Please help, I am so frustrated with myself for not even knowing what I am feeling
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    About ajbrubak

    Joined: Jan '16; Posts: 2


  3. by   boquiabierta
    I work postpartum, not L&D, so I have exactly zero experience in checking cervices. That said, can you possibly get a more experienced nurse or an MD or midwife who you feel comfortable with to help you out the next time you have to check someone's cervix? Or try your best and if you're still not sure what you're feeling, say "hey, would you mind double-checking her cervix with me? I don't get to do this very often and I want to be sure of what I'm feeling."

    Even though I check funduses all day long, occasionally there are patients with difficult-to-find funduses or anatomy that makes me uncertain if what I'm feeling is the fundus, muscle/abdominal tissue, or even occasionally the bladder. On those occasions, even though I've been postpartum for >2 years, I don't hesitate to call another nurse in to do a fundal check with me. You should always be able to ask for help when needed and especially for assistance in learning something you don't get a chance to do often enough to feel comfortable doing.
  4. by   ssrn13
    Hello! I too had a problem with this for my first few months on L&D. Honestly, it just takes practice and take opportunities to familiarize yourself with the vaginal tissue and cervix on moms who have epidurals! The trickiest part of finding a cervix is when the cervix is totally closed. However, once it starts dilating you just need to find the opening of the os. Usually when a cervix was hard to find for me, it was because of a few things...a) the cervix was still very posterior (in which case curving your fingers up and around as you reach the back can help) b) the cervix was not midline (sometimes happens when the baby's head is transverse) and you have to feel off to the side to find it, or c) the baby's head was not engaged and in -4 station and it was just too high to reach.

    That said, I think the "approach" that worked most for me was to run my fingers along the posterior vaginal wall (vs just going through the middle) and keep going until I hit cervix...and sometimes that meant that my fingers and hand had to really stretch. Sometimes if the cervix is very high and posterior, having the patient make a fist with both hands and put them under their hips can help adjust the pelvis and make it easier to find the cervix.

    That's my advice for what it's worth, it may not be that helpful. But maybe it will give you a few ideas. Don't give up, you'll get the hang of it!
  5. by   IndyMitchell
    I worked 5 yrs PP now on the LD flooor almost 2 years. I try to check intact moms with epidurals. To get practice. I work at a teaching hospital so it is hard to get a chance but I also have residents that ask me to check after them which gets me practice also. Just keep trying g to get some checks in.