Session 2

History and Trends of Maternal

Health Nursing in Oman
 Objectives
1. Review the history of Maternal Health
Nursing in Oman (SDLA)
• Refer Introduction to Oman Health Care
System course syllabus and other related
resources such as Annual Health Report of
the MOH in Oman
2. Discuss recent trends in Maternal
Health Nursing
 Content
• Trends in healthcare environment (p.g 15-18)
• Health care concerns and attitudes (p.g 18-19)
• Annual Health Report MOH Oman
Trends in Health Care Environment
1. Initiating cost containment (managed care)
2. Changes in health insurance coverage
3. Increasing alternative settings and styles for health care
4. Increasing use of technology
5. Meeting work needs of pregnant and breastfeeding women
6. Regionalizing intensive care
7. Increasing use of alternative treatment modalities
8. Increasing reliance (support) on home care
1. Initiating Cost Containment (managed care)

• It is about reducing the cost of health care

while maintaining quality of care. For
example: taking care of the items that used
during patients’ care.
• It has direct implications and effects for MCHN
because lack of financial ability to pay, result
in not obtaining prenatal care or not attending
well child care. For example: wasting
medications.
1. Initiating Cost Containment (managed care)

How to reduce the cost of health care? What

healthcare professionals should do?
•Monitor the cost of personnel
•Use brands of supplies
•Limit length of hospital stays
•Limit number of procedures carried out
•Limit number of referrals requested
Managed care resulted in:

•Limiting the number of hospital days = reduce

infection
•Limit number of referrals = not overcrowded
within the health institutions
•Changing the roles of personnel = knowing
their roles and responsibilities
•Delegation of responsibilities = reduced
confusion and improve pt. care
 2. Changes in Health Insurance Coverage

• In USA, before Affordable Care Act (ACA) in

2010, healthcare system was privately
financed by work sites.
• Now, after 2010, national health insurance
has been available to everyone and with no
connection to a person’s employment.
• USA spent more money to healthcare in
comparison to other countries.
 2. Changes in Health Insurance Coverage

• Nurses in MCHC have important role at

healthcare agencies to ensure people receive
comprehensive care and encourage more
children and women to receive preventive
care.

Prevention is better than cure= Health

Education
3. Increasing Alternative Settings and Styles for
Healthcare

• Recent trend is choosing child birth again in

home or alternative birth settings rather than
in hospitals.

• It increases the nursing responsibility for

assessment and professional judgment.
 3. Increasing Alternative Settings and Styles for
Healthcare

• Hospitals refer the labour and delivery suites as

birthing rooms, or labour-delivery– recovery or
labour-delivery–recovery–postpartum rooms.
• Partners, family members and other support
persons are allowed to stay with woman during
child birth (Homelike environment).
• Couplet (joined) care-care of both newborn
and mother by primary care nurse.
3. Increasing Alternative Settings and Styles for
Healthcare
• Healthcare setting for children also is
changing to client’s home, community
centers, schools, retail setting emergent care
clinics or group homes.
• Ambulatory or non-hospital based care
require intensive health teaching by nurses
and follow-up by community health nurse.
 4. Increasing Use of Technology

• Nurses must be expert in using these

advanced technologies as well as explaining it
to the family.

• FHR by Doppler.
 5. Meeting Work Needs of Pregnant and
Breastfeeding Women
• 90% of women work outside their home during
pregnancy. Following the birth, women need a leave
from work to care their newborn.
• Women get 12 weeks of unpaid leave.
• In 2010, Patient Protection and Affordable Care Act
had been signed to provide reasonable breast time
for breastfeeding women to express their milk.
• This law allowing women to breastfeed while
working.
 6. Regionalizing Intensive Care
• Centralized maternal or paediatric health
services are established in a site that is
properly staffed and equipped for potential
problems. Ex. DS is near SCBU. DS have OP
theater.
• Client may be far away from home settings,
family members and family doctor, may be
worried about the outcome. Ex. Mother can
stay with her newborn if admitted in SCBU.
• Communication is given importance in this
situation for giving support.
 7. Increasing Use of Alternative Treatment
Modalities
• Use of alternative therapy like acupuncture or
meditation are increasing in addition to
traditional health care.

• Nurses should be aware of these as it may

have an enhancing or retracting effect on the
traditional therapies. Nurses need to know if
the alternative Rx has any – or + effect to pt.
 8. Increasing Reliance on Home Care

• Short hospital stay resulted in return home of

mothers and children before they are able to
take care of themselves. Usually after 24
hours.

• Nurses should assess mother and baby on

discharge to help plan the best type of
continuing care.
 Other Trends in Healthcare
Environment
• Including the family in health care - (family
centered care)
 Encouraging family participation in child care.
• Increasing the number of intensive care units
 Technical advancement resulted in ICU
settings which increases the opportunities for
advanced practice nurses. NICU-for LBW
babies (SCBU).
 Other Trends in Healthcare
Environment
• Increasing comprehensive and collaborative
care settings
This is established to meet all of a child’s or
woman’s needs in one setting (MCH). A
trusted primary care provider (family nurse
practitioner) should help a family and
coordinates the various specialized services
when needed.
Healthcare Concerns and Attitudes
A. Increasing concern for quality of life: Not
only focusing in physical needs of women and
children but also psychological needs.
B. Increasing awareness of the individuality
and diversity of patients: Each individual
have different needs due to family structure,
cultural background and socioeconomic level.
C. Empowerment of healthcare consumers:
Family and individual are responsible for their
health by learning preventive measures.
 A. Increasing Concern for Quality of Life

• Apart from assessing physical health,

psychosocial aspects of life is also important.
• Good interviewing skills are important to elicit
this information at healthcare visits.
• Example: pregnant student can not be
excluded from school.
 B. Increasing Awareness of the Individuality
and Diversity of Patients
• Varying family structures, cultural back
grounds, socioeconomic levels and individual
circumstances leads to unique and diverse
clients.
 C. Empowerment of Healthcare Consumers

Nurses can promote empowerment by:

 Respect clients views and concerns.

 Encourage participation in activities of care.
 Keep them informed.
 Help them to make decisions about care.
 Health Indicators in Oman among
Omani Population
Year 2016 2017

•Birth rate- 33.7 33.5

•Fertility rate 4 4
•Fetal death rate (still birth) 7.9 ---
•Infant mortality rate- 9.2 9.5
•Maternal mortality rate 13.4 20.2
•Under five mortality rate 11.7 11.6
•Neonatal death rate 120 125
•Perinatal death rate 33 38
•Childhood mortality rate 0 1