Tips for vaginal exams?

I've been working in labor & delivery for the past 16years and determining cervical dilatation, effacement and especially fetal station was a challenge for me in the beginning, especially when another nursecome s behind you and her exam is slightly different. But I learned very early from my mentor and the physicians that no two fingers are alike. I've had physicians check a patient immediately after and get a different results. But one of the physicians put me at ease by saying don't worry if you are slightly off.

For example if I say cervix is 4cm, 80% effaced, -1 station. Another person says 3-4cm, 90%, 0 station. In this example, there is not much of a difference. However, there is a significant difference in example 2: 9cm, 100% effaced, +2 station verses 5cm, 100%, -1 station.

Remember that no two fingers are alike. For me if I'm able to slip one finger into the cervix, it was 1cm; 2 fingers comfortably was 2cm, 2 fingers and gap between both fingers was 2-3cm or 3cm and so forth depending on how wide I can spread my fingers.

At 10 cm, no cervix or rim can be felt at all.

Effacement

The cervix thins out as it is dilating. Normal cervical length before labor begins is about 2-3cm long. As the cervix dilates or labor progresses, the length shortens or "efface". This is described in percentages and in relation to the original length of the cervix. For example, cervix is 50% effaced if it is half in length and 100% when you can no longer feel the length or completely "thin out".

The one best advice I can give is to practice, practice, practice especially if you have a patient that has an epidural. Don't get discourage, lady parts exam takes practice and you get better the longer you stay in the specialty.

Thank you so much! Very informative, I appreciate you taking the time to explain it all!

it was my pleasure

All I can say is that I promise you will eventually get it. I have only been in L&D for 5 months and it took me probably 6 weeks before I can say for sure that I found the cervix. Everyone tried to describe it to me but until I actually felt it and figured things out...I'm still working on figuring out the station though.

I worked L&D for 12 years -my advice is take your time. it may be awkward to be in the lady parts for that long but rushing will not help teach you to get the feel of vag exams. I agree with the previous posts -exams are slightly objective. We had a plastic model in each room that showed the dilations from closed to 10cm -the circles were raised so you could practice on it. You'll get it soon enough!

I think someone posted this somewhere on here before, but if you google "Joyous Birth, learning your cervix", there is a great article. sorry, i am a bit technically challenged to post links - lol

also, i agree with other posters, it takes time to feel comfortable. good luck!