VE's and small hands...help!

[Wittyone]

Are there any midwives or L&D nurses out there who have trouble "reaching" during a VE due to small hands/short fingers? I have very petite hands (my wedding ring is a size 3 or 3.5), and I'm having a terrible time learning VEs.

My measurement from the base of my thumb to the tip of my middle finger (diagonal conjugate measure) is 11 cm, which doesn't seem that small. But...I almost always have trouble finding the cervix, I can never reach "around to the back" to assess an open cervix, and I certainly could not reach far enough to do a cervical stretch or sweep membranes - I can't reach into a cervical os unless the baby is *really* low. My ring finger knuckle presses really hard on the woman's perineum, so I can't just "reach deeper."

Oy! It's not that I want to mess around in there, I would just like to be able to do a decent assessment (especially when my preceptor is standing there saying well, what do you think? )

So, any tips or commiseration? Is this normal or am I as handicapped as I feel in this area?

[CarolynnMarilynn]

You can try having the woman make her hands into fists and then put them under her hips to tilt the pelvis, allowing you to mayber feel her cx better. It works well for really posterior cx too.

[MsBlack]

I can only give commiseration...I too have smallish hands. Sometimes what works is that I go in as far as I comfortably can, and then with my hand just resting there I tell the mom that I am going to need to exert some pressure to get in far enough. I ask her to please take a big deep breath, and when she lets it out to try to consciously relax to my hand. Always reassuring her that I will stop if it gets to hurt or be too much in any way. If she can relax more, and you give firm but gentle pressure inward, often more can be felt. Of course, I do not wear rings, and do try to be careful just where that pressure is going as well as being sure my glove is well lubed--don't want to be pushing against her clitoris, or inadvertently pulling on pubic hairs.

But then I do very few VEs overall. If I do, and find a cervix so posterior that I can barely reach the os, then I assume a couple of things--one is that more labor needs to happen, to bring the cervix forward...I don't much hold with pulling on a cervix (never have yet), so I employ patience and comfort measures to good effect. The other is that the cervix is likely to be no more than 2-4cm--I say this because most often when a posterior cervix does come forward more, that is when it has opened to 4 cm or more. I'm sure there could be exceptions (as there are to everything), just saying this has been my experience.

[nashvillemidwife]

I agree with everything you said, MsBlack!

[Wittyone]

Originally Posted by CarolynnMarilynn

You can try having the woman make her hands into fists and then put them under her hips to tilt the pelvis, allowing you to mayber feel her cx better. It works well for really posterior cx too.

Thanks...I had heard this tip long ago and forgotten it. I'll give it a try

Originally Posted by MsBlack

...I don't much hold with pulling on a cervix (never have yet), so I employ patience and comfort measures to good effect.

I wish my preceptors held this view! I've been told several times that I just need to learn to be more aggressive, to use my fingers to "walk" the cervix forward, etc. They seem to think that it's ok for an exam to hurt in order to get the assessment, and I'm just not on board with that Thanks for the reminder that it's okay (preferable!!) to be slow and gentle.

[Charmie981]

Originally Posted by Wittyone

Thanks...I had heard this tip long ago and forgotten it. I'll give it a try

My caution with doing this would be to tell the mama that because you have small hands, you'll need her to help. I've seen many women get defeated when asked to put their fists in their back because GENERALLY that's not a good sign and means that there's not much dilation going on (as Ms.Black said). In this case, though, it's more than you have small hands than anything else.

I don't have small hands, but when I find a posterior cervix, I find it helps to ask mama to bear down a little bit during the exam, or baby is ballotable, to apply very slight pressure to the fundus to encourage baby to move down a bit (but not "fundal pressure" as in the pushing on baby to get it out kind of thing!!), which will in turn move the cervix down a little bit.

[sevenkids]

Originally Posted by CarolynnMarilynn

You can try having the woman make her hands into fists and then put them under her hips to tilt the pelvis, allowing you to mayber feel her cx better. It works well for really posterior cx too.

That's what I do, I have small hands, too.

If a cervix is posterior, either labor hasn't really begun, or the baby is OP, or Surprise! breech. Usually they're only 2-4, but I had one recently that was waaay posterior and 8 cms. Very odd.

[maxmama]

Fists under butt.

BEsides, trust me, you're better off than having to go get size 8 surgical gloves. Mamas do not like the giant paws I wield (in theory; they actually do fine during the exam).

[nashvillemidwife]

It's true that sometimes it's necessary to just suck it up and be aggressive. Be honest with the mom. "I need to do a thorough exam to see exactly what's going on. I know it's going to be uncomfortable. I'm sorry." Luckily the need for those exams are seldom. My fingers aren't as short as yours but I do have trouble reaching the cervix when it's posterior and I feel the same way as MsBlack. If I can't reach it, there's probably nothing going on.

[Charmie981]

Originally Posted by nashvillemidwife

Be honest with the mom. "I need to do a thorough exam to see exactly what's going on. I know it's going to be uncomfortable. I'm sorry."

Absolutely. I feel that it's better to be thorough than to have a mom go through the stress of a VE and come out of it with wishy washy information. When you do a VE and are unsure of the results, either you'll have someone check after you or (if you're on your own), you'll wonder what's going on and possibly do another VE sooner than you normally would. The intervention of two VEs close together is IMO, about equal with the intervention of doing a thorough VE that mama has been prepared for (and CONSENTED TO!) ahead of time.

Of course, when you're on your own, you can just opt to not ever to VEs . I've had many mamas have babies with not one single VE and I love that for them (and for me!).

[Wittyone]

Originally Posted by maxmama

Fists under butt.

BEsides, trust me, you're better off than having to go get size 8 surgical gloves. Mamas do not like the giant paws I wield (in theory; they actually do fine during the exam).

The grass is always greener, isn't it?

Originally Posted by nashvillemidwife

It's true that sometimes it's necessary to just suck it up and be aggressive...

Originally Posted by Charmie981

Absolutely. I feel that it's better to be thorough than to have a mom go through the stress of a VE and come out of it with wishy washy information.

nashvillemidwife and charmie - thank you for these perspectives! The way that you both explained the time and the place for discomfort is very helpful. And yes, if I'm going to be in there anyway I might as well be getting as much info as possible. Of course, that's my problem to start with...not being able to reach the "info"

Thank you to everyone who is responding, I am feeling better and have a few ideas of things to try. Please keep the tips and commiserations coming - your words are so soothing to this bruised and battered ego of mine

[homewithtwinsmama]

Originally Posted by MsBlack

I can only give commiseration...I too have smallish hands. Sometimes what works is that I go in as far as I comfortably can, and then with my hand just resting there I tell the mom that I am going to need to exert some pressure to get in far enough. I ask her to please take a big deep breath, and when she lets it out to try to consciously relax to my hand. Always reassuring her that I will stop if it gets to hurt or be too much in any way. If she can relax more, and you give firm but gentle pressure inward, often more can be felt. Of course, I do not wear rings, and do try to be careful just where that pressure is going as well as being sure my glove is well lubed--don't want to be pushing against her clitoris, or inadvertently pulling on pubic hairs.

But then I do very few VEs overall. If I do, and find a cervix so posterior that I can barely reach the os, then I assume a couple of things--one is that more labor needs to happen, to bring the cervix forward...I don't much hold with pulling on a cervix (never have yet), so I employ patience and comfort measures to good effect. The other is that the cervix is likely to be no more than 2-4cm--I say this because most often when a posterior cervix does come forward more, that is when it has opened to 4 cm or more. I'm sure there could be exceptions (as there are to everything), just saying this has been my experience.

I have small hands and find all of the above to be true as well. My theory is God gives the good midwives/apprentices small hands so they will be humble and not meddle when they ought to wait.

I have no theory on large handed midwives (nor do I believe you can't be a good midwife if you have large hands - so please don't jump on me if you do). This is just what I tell myself when I can't reach anything. I figure I am at a point where I am just not supposed to know.

[Wittyone]

homewithtwinsmama ~ I like your thinking

[Peppamint]

Short fingers here too... I try to carry small gloves for when I work with the medium glove midwife because I hate baggy gloves. I've only done a VE on one client and she was 8cm so I didn't have any trouble.

I've been thinking that having small hands must have it's advantages and disadvantages- I can see that I was right. I'll have to catalog these tips for myself for those occasions when I need a little help.