The Cervix hunt

  1. I had read here that the best way to find the cervix is to go straight in slowly (feel the posterior rim) and explain everything to the pt (warm hands help).. then proceed anteriorly until you feel the other side. I am having so much trouble it all feels lumpy and bumpy and I can feel one side of the cervix, but not the other. I've only done 3 SVE but I'm really worried I'm never going to get it.

    Any words of advice or encouragement? Any good stories?
    Last edit by Mary C on Apr 16, '09
  2. Visit Mary C profile page

    About Mary C, MSN, RN, CNM

    Joined: May '06; Posts: 214; Likes: 45
    CNM; from US
    Specialty: 8+ year(s) of experience in CNM


  3. by   GilaRRT
    I have never performed that particular hand shake; however, we often talk with nurses who do exams on patients we fly. The exam is more of an art than science in many ways, and the findings are rather subjective from provider to provider. In addition, when I have to to OB rotations for clinical competency, the nurses I have talked with all say you literally need to perform hundreds of exams before you "get it."
  4. by   ElvishDNP
    Everybody's anatomy is different, and some cervices are *right there* and others you have to hunt for. Warm hands and going slowly do help.

    Does your hospital have, for lack of a better way of putting it a 'vagina in a box' that you can practice on? (I've heard other, less polite terms too, but will stick with this one.) That helps too.

    It is one of those things like starting an IV - the more you do it the better you'll get at it. I'm no expert here and there are others who will come along with better advice, I'm sure. But if you've only done 3, please don't beat yourself up! You're just starting out! It will come, and it might just click one day and no more worries.

    If it makes you feel any better for the moment, everybody has had trouble, and sometimes even the docs (sometimes especially the docs) can't figure out what everything is in there.
  5. by   epiphany
    I can try to help you, but are you talking about an L&D exam in term labor or a regular exam?
  6. by   Mary C
    Wow, thanks for the advice, everyone. That makes me feel much better!!!!

    Also, I am talking about SVE in term low risk labor. Thanks SO much for all of your help/replies!

    I HAVE been lucky enough to play with the box o' fun including a metal model with interchangeable cervices! Cool! However even a babys head at station -1 pushing down makes it harder to feel around.
    Last edit by Mary C on Apr 16, '09
  7. by   LDRNMOMMY
    Elvish gave some great pointers! It's one of those things you will learn with job experience. I have small hands and short fingers so sometimes I have a hard time finding a posterior cervix that is -3 or higher. What helps me is turn a bedpan upside down and place a towel on top and place it under the woman's buttocks. It helps tremendously.
  8. by   mee6
    First don't stress it takes a LOT of checks before one gets it and then sometimes it is still hard. Start "practicing" if able on an epiduralized multip. They are usally not thinned out as much (at first) as a primip in labor. When you find it you will definitely have that "ah ha" moment:bowingpur. Also good idea about pt. that you feel are really posterior, have them sit on their fists or bedpan!
  9. by   ElvishDNP
    We do the bedpan trick a LOT with our pretermers.
  10. by   Spidey's mom
    Yep - takes time and POSTERIOR is usually where they are hiding. The bedpan trick is a good one.

  11. by   ElvishDNP
    At the risk of sharing TMI - my CNM, who knows I'm an OB/Gyn nurse, kids me about my posterior cervix. "Ok, now it's gonna feel like I'm checking your tonsils...." It really does feel that way on a posterior.
  12. by   Spidey's mom
    Quote from Elvish
    At the risk of sharing TMI - my CNM, who knows I'm an OB/Gyn nurse, kids me about my posterior cervix. "Ok, now it's gonna feel like I'm checking your tonsils...." It really does feel that way on a posterior.
    My uterus is (was) tilted too . . . . .after 4 kids now I'm not sure.

  13. by   RNBelle
    Beware of the inner and outer os..... One time I thought the lady was 4-5 got her epidural and checked her after...she was only 1! Oops. She did progress and had the baby a few hours later. Love the bedpan trick! Works every time!
  14. by   zyna15
    You can also try to have your pt put both her fists under her bottom. That way, the pelvis is rocked and it is easier to find the cervix, even if it is posterior! And patience! Practice makes perfect!