Pamela Meharry, PhD, CNM, RN, first arrived in Rwanda in 2015, part of an ambitious initiative to train the healthcare workforce in the post-genocide country in east Africa.
Pamela Meharry, PhD, CNM, RN
She was there to co-teach in the newly created Bachelor of Science in midwifery program at the University of Rwanda.
But in a short time, Meharry saw a need for more than a bachelor’s program, envisioning an advanced degree where midwifery leaders could be cultivated on Rwandan soil.
“The midwives I taught with had either gone abroad to Australia, Canada, Scotland, South Africa, or Uganda for their midwifery master’s degree, or completed a master’s program in another discipline,” she says. “When I first started talking about a master’s in midwifery, [my colleagues] said, ‘you’ll have 50 people signed up on day one to join that class. So many midwives wanted to do it, but there was no program.”
Following years of planning with other stakeholders, Meharry’ s vision will become a reality in April, when the inaugural class of students will begin in the Master of Science in midwifery program at the University of Rwanda.
Reducing mortality rates
The University of Illinois Chicago (UIC) School of Nursing hired Meharry – who was working in Connecticut as a midwife and instructor – to travel to Rwanda under the banner of the Human Resources for Health Program, the largest U.S. academic global health consortium to date.
Meharry was paired with the head of the midwifery department and co-taught bachelor’s degree and master’s degree students in the neonatal nursing program, but she observed that a master’s in midwifery program was also sorely needed to develop teachers and leaders.
There were eight other masters’ programs in the School of Nursing and Midwifery at the University of Rwanda, though none that specialized in midwifery or women’s health.
She adds that midwives are considered vital assets in the global effort to lower maternal and infant mortality rates. In Rwanda, those rates have decreased significantly over the last 20 years, but there is more work to be done to reach U.N. Sustainable Development Goals by the benchmark year of 2030, she says.
UIC Nursing shares curriculum
With permission from her Rwandan department head to begin pulling together a curriculum, Meharry contacted UIC Nursing’s then-associate dean for global health Linda McCreary, PhD ’00, MS ’93, BSN ’73, RN, FAAN, and nurse-midwifery program director Carrie Klima, PhD, MS ’86, CNM, FACNM, FAAN. Those colleagues shared with her the UIC DNP nurse-midwifery curriculum, giving her a strong basis from which to develop a curriculum appropriate for a new master’s program at the University of Rwanda.
Meharry was involved in curriculum development even as she conducted a Fulbright teaching and research grant in Zimbabwe in 2019 and 2020. The new master’s program was approved in November 2021.
Meharry says this will open doors for midwives.
“At the master’s level, well-trained midwives [can] assume a leadership role in training midwives, increasing competencies and critical decision-making skills, stimulating research and publications, and integrating more evidence-based practice into health facilities,” Meharry says.
Developing research and study abroad opportunities
During her seven years in Africa, Meharry has also played a vital role in mentoring student researchers, helping 27 nursing master’s graduates publish articles in issues of the Rwandan Journal of Medicine and Health Science.
These publications have become a labor of love and significantly enhance the graduates’ prospects of promotion and PhD studies,” Meharry says. “We now have six graduates in the new PhD program, and they [recently] presented their doctoral proposals to the faculty for review.”
Meharry also helped the head of the midwifery department to publish her master’s research and is now co-supervising her PhD research.
Originally from New Zealand, Meharry says she loves Rwanda’s temperate climate and open spaces. However, what keeps her there is the opportunity to help build programs and develop a research-rich environment, which she finds very rewarding.
She’s hoping to pass that enthusiasm on to UIC Nursing students by serving as faculty director for a month-long Rwanda study abroad program in July 2022 — Global Maternal and Child Health in Rwanda – the first maternal and child health course offered by the UIC Study Abroad Office.
For centuries, nurse midwives have been partners and guides in women’s healthcare around the world. They carry out their compassionate care wherever it is needed as a woman progresses through her life. Nurse midwives are best known for their care during pregnancy, childbirth, and the post-partum period, but they can assist women throughout each stage of their lives—from the teen years to women past menopause.
Nurse midwives deliver services in homes, hospitals, birth centers, and other healthcare settings. They are there to carry out routine physicals through to newborn care.
Although there are several types of midwives, certified nurse midwives (CNM) have a degree in nursing and a graduate degree in midwifery nursing plus additional training and specific certification (through the American Midwifery Certification Board) in midwifery. CNMs are able to prescribe medication. Certified midwives have degrees in an area other than nursing, but then progress through the same certification process. In the United States, the overwhelming majority of midwives are CNMs.
Midwives have always played an important role in patient-focused healthcare as their care approach is directed on the patient and what she needs at that given point in time. Every woman’s body is as different as her healthcare needs, so midwives are trained in assessing each woman’s individual situation to bring her the best healthcare possible.
Most midwives work as part of a woman’s healthcare team, and spend direct one-on-one time to establish a trusting relationship and to learn what the woman wants from her healthcare. Nurse midwives provide their patients with plenty of education so they can make the best, most informed, and most comfortable decision for themselves.
And a nurse-midwife provides the essential hands-on care during labor and delivery, offering both physical comfort and emotional support. Especially during a low-risk pregnancy and birth, the guidance and presence of a nurse midwife gives a woman a greater sense of control as labor progresses and reduces the occurrence of interventions like a c-section while raising the percentage of new moms who initiate breastfeeding.
According to the ACNM, “In 2014, CNMs/CMs attended 332,107 births—a slight increase compared to 2013.” Those numbers amount to about 8.3 percent of all US births. The expertise provided by nurse midwives coupled with the patient-centered and customized plan of care is becoming an increasingly popular option for women who are seeking more personal care from a highly trained professional.
This week, celebrate the nurse midwives in your life with a acknowledgment of how their steady care helps moms and babies throughout the world. If you are a midwife, this is a good time to share your story and call attention to your profession. Post on social media using #MidwivesMakingStrides and share your patients’ feelings about nurse-midwife care.
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