Uncomfortable feeling during dilitation check?

ktliz · Sep 23, 2011

Are you required to do scheduled checks? If they are that high up, I don't even see the point... you can just say they are in early labor. Cervical checks are pretty overrated in my opinion, lol.

klone, MSN, RN · Sep 24, 2011

Are you required to do scheduled checks? If they are that high up, I don't even see the point... you can just say they are in early labor. Cervical checks are pretty overrated in my opinion, lol.

I totally agree. If they're that high, then it's not relevant. Birth is not imminent. Honestly, in that situation, I might make something up just to appease the physician. Yep, she's 1/20/high/ballotable.

MKS8806 · Sep 24, 2011

Our doctors require us to give an update every 2cm or 2 hours. I certainly wouldn't make something up!! If their not contracting, we don't necessarily check them, but if their a pit induction, then we check them.

I think as you become more secure and confident in your skills, you'll become more comfertable.

Kooky Korky, BSN, RN · Sep 24, 2011

I totally agree. If they're that high, then it's not relevant. Birth is not imminent. Honestly, in that situation, I might make something up just to appease the physician. Yep, she's 1/20/high/ballotable.

Surely you are not seriously stating on this public board, that anyone in the whole world can read, that you recommend falsifying a medical record or a verbal communique with a physician.

I know you are only kidding, right? :uhoh3: :eek: :jester:

CoffeeRTC, BSN, RN · Sep 24, 2011

Well, as a mom of 5 I can tell you that it is uncomfortable, but it is part of the care provided. Not an OB nurse, but I would say that what ever the policy is thats is what it is.

Sometimes we do things that are uncofortable to our pts..(foley caths, IV inserts etc) This is the reason I can't give injections to little kids..vaccines are necessary, but they hurt..same concept as your above question.

klone, MSN, RN · Sep 24, 2011

Surely you are not seriously stating on this public board, that anyone in the whole world can read, that you recommend falsifying a medical record or a verbal communique with a physician.
I know you are only kidding, right?

Oh, for goodness sake.

If I can feel the edge of the cervix, but it's so far up that I can't even reach one finger all the way through, then I say "it's thick and high" even though I wasn't able to verify exactly HOW thick and how high. If it's so high that she has to sit on her hands and I still have to do fundal pressure to bring the head down enough and it's so posterior that I can't reach the whole thing, then 1/thick/high is good enough.

I don't consider it "falsifying" anything, but rather, giving an accurate enough assessment while towing the line of not traumatizing the woman. I don't think it's necessary to dig so hard that she's in tears, when we all know that if it's THAT hard to find the cervix, then she's not about to have a baby, and the exact numbers are not important (except to the intern who is managing her care and is more focused on the concrete than the big picture).

If you find "making an educated guesstimate" to be more palatable than "making it up" (which I used somewhat TIC), then feel free to substitute that instead. :)

klone, MSN, RN · Sep 24, 2011

Well, as a mom of 5 I can tell you that it is uncomfortable, but it is part of the care provided. Not an OB nurse, but I would say that what ever the policy is thats is what it is.
Sometimes we do things that are uncofortable to our pts..(foley caths, IV inserts etc) This is the reason I can't give injections to little kids..vaccines are necessary, but they hurt..same concept as your above question.

There's a difference between "uncomfortable" and "traumatizing" though. I don't fully understand it because from a patient's perspective, lady partsl exams, blood draws, IV starts, etc, are uncomfortable, sometimes painful, but just something to accept and endure. But surely you've met a patient for whom an IV start or a needle of any kind is more like a pathological fear. For some women (often due to sexual abuse), lady partsl exams are more than just uncomfortable or slightly painful. It reduces them to tears, and it causes extreme anxiety. Actually, it's more common than many people think or understand. I think it's absolutely wrong to subject those women to an invasive vag exam where you have to dig around and cause a lot of pain because you just HAVE to get the exact numbers. If that makes me a bad nurse, oh well. I'll accept that, but I'm not going to change my ways. For women who find exams to be extremely mentally and physically traumatizing, "good enough" is just that.

bagladyrn, RN · Sep 24, 2011

I can understand not wanting to traumatize someone who obviously has some kind of negative past experience. However, "making up" a cervical check seems wrong to me. In those cases I have no problem reporting or charting that the cervix was too high and posterior to check.

The big problem I'd see with not putting down that you were unable to assess is that if you proceed from there, especially with pit or such is that you could end up dealing with a breech or other malpresentation further along in labor. Saw that happen with a midwife who didn't do cervical checks. Not good when your first clue is seeing the presenting part!

Also, the fact that a woman is so uncomfortable (or worse) with exams is important to note so that her providers can help her through the experience of a lot more sensation in the area as she gives birth.

klone, MSN, RN · Sep 24, 2011

The big problem I'd see with not putting down that you were unable to assess is that if you proceed from there, especially with pit or such is that you could end up dealing with a breech or other malpresentation further along in labor. .

That would definitely be a concern. At the facility I most recently worked at, we never start inductions without a quick bedside U/S to verify positioning. We never go by exams to verify vertex.

njmomstudent · Sep 25, 2011

I'm not a nurse yet, but for me, the check was awful. It wasn't too bad until I started having real contractions. I think some women are more sensitive than others. For some women it's simply uncomfortable. For me, my uterus would clamp down like nobodies business when my cervix was irritated. Add that to the fact I was having back labor and I was NOT a happy camper when she would come check me. Thank God the facility did not require checks that frequently otherwise I would have ended up kicking someone. No nurses did the checks, only the OB's or midwife. My midwife didn't exactly have a gentle manner about her surprisingly... think rotorooter in your lady parts while having contractions. I totally agree with the person that said if you have a difficult time finding it, just let it be and don't go digging for it.

snazzy-jazzy, BSN, RN · Sep 25, 2011

There's a difference between "uncomfortable" and "traumatizing" though. I don't fully understand it because from a patient's perspective, lady partsl exams, blood draws, IV starts, etc, are uncomfortable, sometimes painful, but just something to accept and endure. But surely you've met a patient for whom an IV start or a needle of any kind is more like a pathological fear. For some women (often due to sexual abuse), lady partsl exams are more than just uncomfortable or slightly painful. It reduces them to tears, and it causes extreme anxiety. Actually, it's more common than many people think or understand. I think it's absolutely wrong to subject those women to an invasive vag exam where you have to dig around and cause a lot of pain because you just HAVE to get the exact numbers. If that makes me a bad nurse, oh well. I'll accept that, but I'm not going to change my ways. For women who find exams to be extremely mentally and physically traumatizing, "good enough" is just that.

I don't think it makes you a bad nurse at all, I think it makes you a great advocate who provides woman centred care... Good on you. If I was having a baby in the U.S I'd want you as my nurse. :yeah: