Vaginal Exams

nitetimeobnurse · May 13, 2007

probably not what you want to hear, but as you get experience you will learn, I had a 2nd year resident tell me to always, decrease what you think by one, and you will be fairly close, and if someone checks behind you and that extra one is there no big deal.

Envy · May 13, 2007

If only 1 finger fits in the cervix--1cm,when you cross your fingers and the 2 fit in--then it's 2cm, if you have your fingers side by side and they both fit in-it's 3, if with 2 fingers there is a small gap--it's 4, if you can fit your thumb between the two fingers-it's 5, 6 is when you fit 2 fingers with the thumb between and a small gap. For 7, 8,9 and 10 you go by how much cervix is left, not how far apart your fingers are.

strn96 · May 14, 2007

My advice would be to practice on a cervical dilation chart for awhile. Place your fingers on the outer edges of the circles on the chart to get a feel for how far apart they will be a 4,5,6, etc. Also, after vag exams, try to place your fingers in the same position they were with the check and compare with the chart. Like a previous poster said, if in doubt, go with the smaller number. (My exception to this is if another doctor or nurse has already told a pt they are dilated to x cm, I will just say no cervical change if I don't think they're really dilated that much.)

And by all means have another nurse check after you if you're not sure about the check.

Experience really is the only way to get comfortable with vag checks.

Good luck in your orientation!

FLOBRN · May 17, 2007

Remember too, everyone has different size fingers so what is 3 to you may not look the same on someone elses fingers. Also remember for a cheap cheat that monitor paper runs at 3 cm so between the dark lines is 3 cm. Thus 2 big boxes is 6 cm. What I used to do with Moms and Dads when I was learning is say, "let me show you on the chart here where you are" . they never realized it was also a personal affirmation as to what I was feeling. : )

SmilingBluEyes · May 17, 2007

Practice, practice, practice. And a good measure of patience. Believe me, it will come.

nurseynightnight · May 18, 2007

My exception to this is if another doctor or nurse has already told a pt they are dilated to x cm, I will just say no cervical change if I don't think they're really dilated that much.)

I tend to go with what I feel someone is. I have charted no change before or the same as what the previous nurse thought so I wouldn't have to tell the patient something different. Then to have a doc come behind me and say what I thought she was initially. So I always say chart what YOU are feeling not what someone else felt. Now I can say that after 5 years of experience. In the beginning I would have nurses check behind me until I became more comfortable with my checks.

I will tell you there are still times that experienced nurses will still have someone check behind them. Especially when it is a very posterior cervix or high baby. They usually grab me since I have the longest fingers on the unit!!

I agree that practice is what it takes. Also have you ever checked your own cervix??

I think it is a good idea to feel what a thick, firm cervix feels like. And it will help you when you are determing effacement. So you know what 0% or thick is.

I also checked my own cervix when I was pregnant and in labor. Helped me to know when to go to the hospital!! Just an added perk of being a L+D nurse!

magz53 · May 23, 2007

I keep my index and middle fingers together and "sweep" from side to side and around the open cervix, you are basically checking the diameter of a circle. Practice on "circles" around the house.......rims of glasses, cups etc. I don't see how anyone can measure by separating their fingers with any accuracy. I have seen a doctor run to the dilitation chart with fingers spread to see how dilated a patient is. Not too confidence inspiring for the patient OR the nurse. You will learn to visualize it as you are doing it. I do not subject a patient to multiple checks if the cervix is high and posterior. If you can't reach it, that tells you enough info right there as far as what the patient is doing....or not doing more like it. Effacement and station come with practice and experience also. I always report exactly what I measure whether it agrees with anyone else or not as I feel I have actually measured. I am not guessing.

**canoehead, BSN, RN** · May 23, 2007

If only 1 finger fits in the cervix--1cm,when you cross your fingers and the 2 fit in--then it's 2cm, if you have your fingers side by side and they both fit in-it's 3, if with 2 fingers there is a small gap--it's 4, if you can fit your thumb between the two fingers-it's 5, 6 is when you fit 2 fingers with the thumb between and a small gap. For 7, 8,9 and 10 you go by how much cervix is left, not how far apart your fingers are.

For the love of all that is good and holy, don't stick your whole hand up there! Two fingers, only, not two fingers and a thumb!

LightningRN · Jul 17, 2007

I don't think she actually meant to put your thumb in. Geez. I took it as meaning if you COULD fit your thumb between. My goodness.

godsweet · Jul 19, 2007

I am not a nurse yet, not until in about 2 years. This fall is my first semester in nursing program.. I think it is funny to read this topic. I have been wondering about it. At least it will give me some ideas but I will find out more later. I am really interesting in L&D nursing.