Cervical Cancer Screening Practices of Certified Nurse-Midwives in the United States


  • Patricia Aikins Murphy CNM, DrPH, FACNM,

    Associate Professor, Corresponding author
    1. University of Utah College of Nursing in Salt Lake City where she holds the Annette Poulson Cumming Presidential Endowed Chair in Women's and Reproductive Health.
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  • Eleanor Bimla Schwarz MD, MS,

    Assistant Professor of Medicine
    1. University of Pittsburgh Department of Medicine, Division of General Internal Medicine, in Pittsburgh, Pennsylvania.
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  • Jane M. Dyer CNM, MS

    Assistant Professor and Director
    1. Nurse-Midwifery and women's health nurse-practitioner educational program at the University of Utah College of Nursing in Salt Lake City.
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University of Utah College of Nursing, 10 South 2000 East, Salt Lake City, UT 84112. E-mail: patricia.murphy@nurs.utah.edu


The purpose of this study was to determine how closely certified nurse-midwives in the United States follow contemporary cervical cancer screening guidelines. A survey was sent to 264 randomly selected certified nurse-midwives. Survey questions included demographics and clinical scenarios addressing initiation, frequency, and cessation of screening. Responses were received from 60% of the sampled certified nurse-midwives who had valid mailing addresses; 127 were eligible for the analytic sample. Many nurse-midwives initiate cervical cancer screening earlier than guidelines recommend; 72% would initiate screening in an 18-year-old within 1 month of coitarche, while 36% would begin screening virginal girls at age 18, and many continue cervical cancer screening after guidelines recommend cessation. More than 60% of the respondents would continue screening a woman who had undergone total hysterectomy for symptomatic fibroids who had no history of dysplasia, and half would continue to screen a 70-year-old woman with a 30-year history of previous normal Pap tests. In addition, despite guidelines which recommend less frequent screening, more than one-quarter (28%) would continue annual screening in a 35-year-old woman with three or more normal tests. Certified nurse-midwives are performing cervical cancer screening more frequently than current guidelines recommend. Comparisons to the practice of other providers are offered. Education to limit unnecessary testing is needed.