Vag exams=super lost. Help!!!

[Brittanyrn89]

Hey guys!

I'm in my 3rd week of orientation for a L&D unit. I need some serious help with SVE's. I feel like I'm completely lost when I attempt any. All I feel is babys head or complete mush and I have never been able to feel the cervix. What am I doing wrong? If I feel the babys head does that mean I need to come out a little to find the cervix? Does it mean that I'm in the cervix? Do I go lower to feel it? When I feel the cervix do I feel for a length and what does that feel like? I feel very confused and Incompetant. Im not able to find any good pictures in a book to help me visualize. Thanks for any input and I have read a bunch of posts on SVEs already but I dont know what I'm doing wrong. Thanks!

[queenanneslace, ADN, MSN, APRN, CNM]

I think it's completely normal to struggle with lady partsl/cervical exams in the first 3 weeks of orientation!

And - just the other day, an OB with many, many years (30+) of experience was talking about how difficult it was to find a patient's cervix because it was so thin and soft - so don't beat yourself up too much! Some exams are tricky!

Just offering you those two pieces of information so hopefully you can be gentler with yourself when learning to do lady partsl exams.

Oh, where to start. Finding the head, or fetal presenting part is good. THAT'S GOOD! :)

If a patient is in early labor, sometimes the cervix is tucked behind the head - so it helps to follow the curve of the presenting part toward the back of the pelvis to find the cervix (sometimes my fingers don't reach!!) Sometimes the cervix can be off to the right or the left. Sometimes the cervix is very thin and it's hard to tell the difference from a thinned out cervix or membranes.

The easiest cervix to feel is 3-5 cm, mid position, and not super thin. Maybe if you're working with a preceptor - if they can tell you if a cervix is easy to feel, you can start there. And honestly, I have days where I check and all I feel is mush - and at the next check, the cervix pops right out in my fingers.

Some say to check when a woman has an epidural -so you can take a little more time feeling without making her uncomfortable. Sometimes checking during a contraction helps the cervix stiffen a little bit to make it easier to feel. Work on learning dilatation first - then effacement - then station.

But it takes some time to learn! I'm pretty sure I had no idea what I was feeling 3 weeks in! You'll get it. It takes time.

[cayenne06, MSN, CNM]

Have you ever tried to locate your own cervix? Obviously it feels different in labor/late pregnancy, but at least it will give you an idea of the anatomy. And yes, this is a skill that is developed over time. It is also highly subjective, despite what you might hear people say.

I've been doing cervical exams for like 12 years, and every once in a while I still have a very difficult exam.

Some time last year, I checked a patient and was SURE she was fully. Nope. 100% effaced, posterior, and a fingertip dilated. Sigh.

[SeattleRS24]

I feel for you!! I completed a new graduate residency program in L&D and have been working on my floor for about 6 months. I have struggled so much with SVEs since the very start, and it's required a LOT of encouragement/education from my peers to keep me from feeling totally incompetent. Don't beat yourself up; the other responders are telling the truth - it's tricky! I just recently had my breakthrough where most of the time, I can at least find the cervix...but that still doesn't mean I necessarily have a confident exam. People with epidurals are deeeefinitely the best to practice on. My best piece of advice is to take your time (when they have an epidural). In the beginning I would honestly spend 5-10 seconds doing an exam; but now I take up to a full minute making sure I have some information before I'm done. You'll get it - and honestly, there is NO shame asking for sometime to check behind you (although I understand how much better it feels to be independent in that skill). Good luck :)