totally missed vaginal exam

cayenne06, MSN, CNM · Apr 6, 2015

Oh yes. And thinking she is fully when she is really 1cm, fully effaced, and very posterior.

It happens to everyone.

As an aside, however- someone can go from 3-4cm to fully dilated in literally minutes, so your exam could have been correct!

NurseNora, BSN, RN · Apr 7, 2015

It happens to everyone. Practice is the only remedy. But from time to time you'll make mistakes once your seasoned too. I still do.

queenanneslace, ADN, MSN, APRN, CNM · Apr 9, 2015

As an aside, however- someone can go from 3-4cm to fully dilated in literally minutes, so your exam could have been correct!

There's that too! I've recently had a couple patients zip along from 2cm to baby out in less than an hour (multips).

I even told the doctor "There's no way she's delivering my shift." Tight, rigid 2 cm cervix, crappy contraction pattern, on Pit, not doing anything - then WHAM-O: "I need to puuuuuuuuuuush!"

Stuff like that does make me question my assessment skills ... you'll get better at it - and you'll learn to trust when you know what you know - and when you're not certain. If you really are uncertain of what you feel - don't be afraid to ask someone else.

It's one of the things I love about OB - you just can't predict. You think you're going to miss this baby's birthday - then they surprise you!

Be gentle with yourself. Even physicians who've checked thousands of cervices will admit there are some tricky exams.

imenid37 · Apr 9, 2015

Definitely missed and disagreed with doc. I have also had doc and CNM say oh I thought you were this and then when rechecked they have gone "backwards." Some multips have a soft movable cervix and it is difficult. A patient who is fully or nearly fully affaced but only 1 or 2 cm can be a challenge too. Do not be too hard on yourself. You will do it for years and still sometimes be wrong.

cayenne06, MSN, CNM · Apr 10, 2015

Also- your stretchy 2-3 can easily be someone else's 4. There is a subjective component to the exam.