Vag exams..

Mods., could we umm...move this to the OB forum??

Hi everyone...I've been doing labor n delivery for a couple of yrs now and am pretty comfortable with vag exams however sometimes i second guess myself....especially with multips...everything just seems mushy down there sometimes...and its hard to say what i think the effacement is and sometimes even the dilation....can anyone give me tips on what has helped them....i want to feel completely confident about my vag exams but sometimes i really am not sure what I am feeling.....does anyone else feel that way??

If I'm not sure I've found it I get someone to check behind me. But usually if I slow down and take my time I find it (hard to do when you feel bad for the patient because she is uncomfortable). Even though I do get people to check behind me sometimes, really, when someone said "don't come out 'till ya find it" they were right... after all, it's in there somewhere! Feel through that mush until you can clearly feel the edges & can feel all the way around the circle. Sometimes I get tricked looking up in China (posterior) and they end up being way anterior and I didn't even really feel there.

Usually I feel fairly confident on the dilation/effacement (at least I usually have about the same result as my coworkers). We have a chart that someone made that has circles with the dilation centimeters (she did it with puffy paint so that makes it better because there's an "edge" for your fingers to stop on). If you could get that or make one, it would probably be helpful if you are still uncertain of your centimeters. People also suggest to test yourself on circular objects around you - cans, jars, etc. Guess & then measure & see how you do.

Different people have different sized fingers and more/less flexibility and stretch for 7, 8, 9, 10.

Some are easy of course: for most people, one finger all the way through the os is 1cm, one with room to move is 2, two fingers fitting snug is 3cm (also equal to one minute span on the fetal monitor paper), two fingers loose is 4, two fingers slightly spread (or perhaps 3 fingerwidths) is 5cm, a 6cm spread is equal to the two minute span on the monitor paper, etc. I know that my fingers can spread to about 7 then I have to scissor them somewhat for 8-9 and of course when I can't feel any it's 10.

Continuity helps, too. If you have the same patient all day then you have something to compare to. If she was 3cm before and now she's a little more then she's obviously 4-5. If it's in that neighborhood I put 4.5 or I'll say "four-to-five". It's not like we have a ruler in there. What's most important is "What kind of progress is she making?" None, slow but steady, or big jumps in change, etc.

Same with effacement. I think that's even more subjective and I agree with people here on the forum who have written that you can usually sum it up with 0-50-80-100 or some kind of increments similar to that most of the time. For effacement/exams in general, I think overall consistency is important too:

Thick or thin?

Hard or soft?

Firmly in place or stretchy? (stretchy I find often coincides with that jelly-ish consistency)

0, 50, 80, 100 = none, half, most, paper thin?

I don't know if that helps any... best wishes :)

]Have someone check behind you I am always a little stingy c my vag exams. I have been doing L&D for more than 10 yrs and there are times when I still have someone check behind me and I do the same for them.

Lisa :wink2:

I so appreciate the tips on vag exams. I usually work with CNMs who are in house and do all the vag exams, plus we are so small we don't birth that many babies (150/yr). Occasionally I get to do a vag exam, and it is so stressful, but I'm grateful for the chance. I just want and need more experience, so periodically I consider going to work out of town in a bigger hospital to get better at this.

indigo