Uncomfortable feeling during dilitation check?

MKS8806 · Sep 25, 2011

I agree about not digging. I've checked and if I can't reach it I report it as that. I don't tell the doctor its something that I can't verify.....

We do not do bedside sonos, although it has been brought up. We had THREE inductions, bam bam BAM, that ended up being breech. Not good.

sharkdiver · Sep 25, 2011

Definitely not my area of expertise, but I had a thought....

In the event where it is traumatizing or unnecessarily painful for the patient, especially in situations when it is of little relevance as some have mentioned, has anyone thought to inform the patient that they have the right to refuse to consent to the cervical exam? Before I get jumped on, I'm not recommending trying to influence them to making that decision, but giving them all the information, both pro and con, and letting them make their own decision - they should at least know that they have that option open to them....just a thought....

klone, MSN, RN · Sep 25, 2011

Definitely not my area of expertise, but I had a thought....
In the event where it is traumatizing or unnecessarily painful for the patient, especially in situations when it is of little relevance as some have mentioned, has anyone thought to inform the patient that they have the right to refuse to consent to the cervical exam? Before I get jumped on, I'm not recommending trying to influence them to making that decision, but giving them all the information, both pro and con, and letting them make their own decision - they should at least know that they have that option open to them....just a thought....

Yes, absolutely. I think a lot of women feel very disempowered during labor, and don't feel like they have a right to refuse anything.

Another good reason to have a doula!

melmarie23, MSN, RN · Sep 26, 2011

Yes, absolutely. I think a lot of women feel very disempowered during labor, and don't feel like they have a right to refuse anything.

Exactly. There is something psychological about being in a hospital bed that renders many disempowered, especially when providers (docs and RNs alike) stand over them, looking down at them, talking down (literally, not figuratively) to them. It can be very intimidating. That said, many choose to believe that their providers have their best interest in mind and default all decision making to them. Its just easier. And I mean, dont get me wrong, health care providers should have the patient's best interest in mind, but defensive medicine does happen, especially in OB.

Regarding cervical checks...I think they are important tools when a woman is induced and/or has an epidural. But for those who are not having either, then they need not be subjected to them and instead their emotional signposts can be used to determine how far along she is progressing in her labor. This is just my own opinion though.

Hushi05 · Sep 26, 2011

I agree with ktliz. There isn't much need to be exact with cervical checks. All you really need to know is closed/long/high, change from last exam, and crowning.

bagladyrn, RN · Sep 26, 2011

I agree with ktliz. There isn't much need to be exact with cervical checks. All you really need to know is closed/long/high, change from last exam, and crowning.

I'm not sure I'd say that's all you need to know. You can't assess change from last exam without a valid initial check. You also will be assessing presenting part, position of presenting part (as in OP, OA, asynclitic, face presentation, hand or cord up there in front of head).

Again, this is an opportunity to assess the patient's reaction and to work with her on relaxation. If she tightens up, jumps or complains when I start the exam I will back off, explain exactly what she might feel and talk her slowly through each step, stopping with fingers on the outside, just inside the opening if I feel her tighten, coaching her to breathe and relax at each interval until she is able to allow me to complete the exam.

L&Dnurse11 · Sep 26, 2011

I am a new grad in ob... If a woman does not have an epidural I feel incredibley uncomfortable doing dilitation checks. The pt usually squirms with discomfort, and it makes me feel bad! Of course I try to be as gentle as one can possibley be, but when they are at a -3/-2 station I have to reach far. Does this feeling go away with time, or how do you cope with it? Am I just being overly sensitive?

I feel the same way! I just graduated in May and started in L&D in June. I have a hard time with it myself. We only do checks when told or as standing orders, usually after Cervidil removal, before an epidural, and if early decels are on the monitor.

klone, MSN, RN · Sep 27, 2011

Why do you do an exam if early decals are present?

MKS8806 · Sep 27, 2011

Yeah, why do you check with earlies? Earlies are normal, its the deep variables and the lates that I would check for, if nothing else.

klone, MSN, RN · Sep 27, 2011

Earlies are still a category 1 strip

EMJrn · Sep 27, 2011

Hey - thanks everyone for replying and bringing up such important points. The situation I was referring to, had to do with a cervidil. I also think that with time I will become more confident and have less anxiety over this type of stuff.

We also check earlies most of the time. Most of our pt's have epidural's, and it clues us into further dilitation and the baby coming down more.

MKS8806 · Sep 27, 2011

Well in that case - we don't check for cervidils or foley bulbs. The doctor will check them when they place it. We would only check if there is SROM or the pt is really starting to get uncomfertable and they are contracting. Otherwise, we don't if they are doing a cervical ripening.