learning vaginal exams

[snugglebug14]

How long did it take you all to feel "comfortable" doing vaginal exams? (meaning you check dilation and are reasonably confident in your findings)

[Reha]

I didn't find it too hard of a thing. Maybe because I was so familiar with the feel of my own cervix?? I don't know. But, I haven't done a whole lot of vaginal exams (maybe 15-20 total since I've been doing primaries). But, I've never felt the need to have my preceptor check after me. It was always pretty straight forward and obvious (and I've checked at many varying points in labor, so I feel like I feel comfortable with my experience). We don't do any routine vag. exams in labor or prenatally, so it has only been when the mother has very strongly desired them, or if there was something going on during labor that indicated an exam.

I think, like so many other skills in midwifery, it is all about confidence. If you can't find the cervix right away, don't panic and ask your preceptor to find it; just take a breath, and picture in your head what you are finding, walk your fingers along the upper vaginal wall if you must, and you will find the cervix.

[Charmie981]

Are you having a hard time finding the cervix or having a hard time knowing how dilated it is *for sure*?

I taught my current apprentice by telling her that she'll be able to know if mom is at one of three different stages once she finds the cervix:
1) she's probably not in labor or is in early labor and her cervix is just starting to change
2) she's in labor and her cervix is changing but she's not having a baby *RIGHT NOW*
3) she's really far dilated and there's just a little cervix left and she may be having a baby *really soon*

This was a trial by fire for her b/c she was checking someone who lived closer to her than me (by 1.5 hours!) and who thought she *might* be in labor but she wasn't. So, I told her to check and see what she felt like according to that scale, then assign a CM value to it...like there are three stages of #1-1-3cm, and there are three stages of #2-4-6 or 7 cm and there are three stages of #3: 7 or 8 to complete.

I learned to trust my findings by measuring everything around me...soda cans, candle lids, bottle tops, anything even close to round. I remembered how it felt for my fingers to be inside something that's 2cm (I have to almost stack them on top of each other), 3cm (they can be side by side comfortably) and so on. I can measure 10cm because it's the point where it HURTS to stretch them that far. If that's the case, then I feel all around baby's head for cervix, to determine if she's complete or "just" 10cm.

Still, though, there are times when I just don't know what I'm feeling! At a recent labor I checked mom after my apprentice, who was unsure of her findings. I determined she was 4cm, but told my apprentice privately that since I couldn't get around to feel the entire cervix, it was possible she was complete with a THICK anterior lip. As her labor went on, I knew she was 4 or so at that check because next time I checked a few hours later, I could feel the whole cervix. Baby had some positioning issues though, and it just wasn't clear in the beginning what was going on!

[teachermom]

thanks charmie. your explination makes it easy to picture the feel of it.