Midwives are well-placed to encourage women to have cervical screening. Professor Julietta Patnick explains how they can help.
In England, women are invited for free cervical screening every three years if they are aged 25 to 49, and every five years for those aged 50 to 64. It is estimated that the NHS cervical screening programme saves up to 4500 lives per year in England. This figure could be even higher if more women were encouraged to attend screening.
There is particular concern about the low uptake of cervical screening among women under 35, especially among 25- to 29-year-olds. Screening attendance of these younger women is 10% lower than that of 30- to 34-year-olds and 20% lower than 50- to 54-year-old women.
Antenatal and postnatal consultations provide midwives with an opportunity to discuss a woman’s cervical screening history. Some women may never have taken up the invitation for routine cervical screening, which starts at the age of 25. Pregnancy and the postnatal period present a woman with an opportunity to ask questions and allay any fears she may have about being screened, particularly if she has ignored several invitations in the past. Also, it is a time when looking after her health affects another person and health promotion advice is likely to be welcomed.
If a woman is pregnant and due for her routine cervical screening, it is advised that she makes an appointment 12 weeks after giving birth. It is not normally recommended that a woman has cervical screening when she is pregnant.
During the postnatal period and before transfer of care to the health visitor, midwives can again raise the importance of cervical screening by asking the new mother whether she is due for screening and encourage her to make an appointment. This should be documented on the communication to the GP, so that they are able to address the issue at the six-week postnatal check.
Some women feel apprehensive about a screening test and may ask for information on what it involves. Again, the role of a midwife can be vital in reducing anxiety and reassuring women, particularly those who may have skipped previous appointments.
Remember to inform women that cervical screening is not a test for cancer. It is a method of preventing cancer by detecting early changes to the cells in the cervix, which, if left untreated, could develop into cervical cancer.
A pregnant woman who has never attended, or has continuously missed her routine cervical screening appointments, may ask her midwife to explain how the process works. Cervical screening consists of a sample of cells being taken from the woman’s cervix using a speculum to open up the vagina and then a small soft brush sweeps around the cervix, taking a sample of cells from its surface. Most women find the procedure only mildly uncomfortable. The sample is then sent to a laboratory and examined under a microscope by a cytologist for abnormalities. Women normally receive their results within two weeks.
Director of NHS Cancer Screening Programmes