title: The cervical cancer screening program from a midwife's perspective.
abstract: BACKGROUND
  Midwives in Sweden are responsible for taking Papanicolaou (Pap) smears as part of the cervical cancer screening program. The aim of this study was to investigate midwives knowledge, experience and management of the cervical cancer screening program, and their apprehension of women's knowledge about Pap-smear screening.
  
  
  METHODS
  A postal questionnaire was sent to midwives working in primary health care in 3 different areas in Sweden. A total of 156 (77%) out of 201 midwives completed the questionnaire.
  
  
  RESULTS
  Four of 5 midwives considered themselves to have the education they needed to manage the screening program. However, the study indicated that midwives lacked a basic structure when giving information. As many as every third midwife refrained from or had an irrelevant answer to the proposed question, what is meant by a cellular atypia? Almost all midwives saw themselves as the main informant about Pap-smear screening. At the same time, the midwives perceived that women lacked knowledge about cellular atypia, and thought it was the same as cancer. Some 38% of the midwives expressed a wish to terminate the 'assembly line-like' screening system. The remaining midwives were completely satisfied with the organisation.
  
  
  CONCLUSIONS
  Many midwives lacked time and a structured guidance when discussing screening and cervical atypia. Improvement in the organisation and certified education for Pap-smear screening with access to recent research, could develop a more empowering exchange between the midwives and the women participating in cervical screening.
authors.affiliation: Department of Obstetrics and Gynaecology, Central Hospital, Karlstad, Sweden. monica.idestrom@liv.se
authors.forename: Monica
authors.initials: M
authors.lastname: Ideström
authors.forename: Ian
authors.initials: I
authors.lastname: Milsom
authors.forename: Agneta
authors.initials: A
authors.lastname: Andersson-Ellström
mesh_terms: D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008880:Midwifery; D065006:Papanicolaou Test; D010353:Patient Education as Topic; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears / Q000379:methods*