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Midwifery In the Sultanate of Oman
						
				
				
						I am privileged to have recently been appointed Professor, Education Advisor,
						Oman Specialised Nursing Institute, Directorate of Education and Training, Ministry of Health. The Institute also provides for midwifery education as a postbasic 
		
		
				(to nursing) 
		
		programme. While I am maintaining my midwifery passion by
		linking education with the maternity service needs through the Directorate of
		Nursing and Midwifery Affairs, I am very much involved in the Office of the Dean
		providing academic and research leadership across all the specialty programmes.
		So for this newsletter I thought I would write something about Oman and
		midwifery.
		
				Oman is a country in the Gulf States that has undergone extensive changes over
				
						the last 35 years. This is due to the vision and foresight of Sultan Qaboos bin Said. When His Majesty
						began his reign in 1970 he stated "I promise you to proceed forthwith in the process of creating a  modern government. My first act will be the immediate abolition of all the unnecessary restrictionson your lives and activities. "My people, I will proceed as quickly as possible to transform your lifeinto a prosperous one with a bright future. Every one of you must play his part towards this goal.Our country in the past was famous and strong. If we work in unity and cooperation we willregenerate that glorious past and we will take a respectable place in the world. "God bless us alland may He grant our efforts success." http://www.omanet.om/english/government/hmspage/tribute.asp (retrieved 4/5/07). 
				Thus began the modernization of Oman and the country 
				has developed and the Omani people have come very far in just 36 years.
		
		
				Oman is an Arabic country following the tenets of Islam. The people are liberal
				thinking and determined to maintain a peaceful co
				
						‐ 
						existence with their 
				neighbours and the Western world. As a developing country the major city,
				Muscat, provides all the amenities of any modern city in the developed world. In the interior people live in a very harsh and isolated environment of mountainsand desert, however, the access road networks are improving all the time. The various conditions in Oman create a challenging situation for the provision ofmaternity services and the role and functions of midwives.
		
				The education model for midwifery practitioners is the nurse
				
						‐ 
						midwife in the 
				
				belief that the practitioner can provide a comprehensive service that includes
				both nursing and midwifery duties. The advantage of a nurse
				
						‐ 
						midwife is the
				
				deployment of skill mix in areas of need. The disadvantages are that ‘midwives’
				work predominantly as advanced nurse specialists in midwifery 
				
						
								(obstetrics) 
						
						and
				
				there is a tension between nursing and midwifery philosophies. Well women in 
				the childbearing period may be treated as ‘patients’ under a medical model.
				There is considerable fragmentation of care with some policy advisers, mostly
				medical, believing that midwives only work as midwives in a delivery suite.
		
		
				Despite this current situation there is a definite paradigm shift as midwives are
				starting to claim their own area of practice. I have noticed a major difference
				
						since I undertook my review of the maternity services during July
						‐Sept 2006 
				
				
						(only
				
				8 months ago) 
				for His Excellency the Minister of Health entitled 
				
						‘Midwifery in Oman: A
				
				
				way forward.’ 
				Quite a few of my recommendations have been acted upon including  setting up a pilot scheme for community midwifery in a selected area of Oman(wilyat). 
		
				This scheme is led by a New Zealand midwife, Lynette Galloway, who has
				been so enchanted by the Omani people that, following her Master of Midwifery
				at Massey University, she returned to spend a year learning Arabic.
				
				
		
		
				The complex health infrastructure in Oman and its reliance on tertiary and
				regional hospitals means that midwives have been unable to practise midwifery
				with a focus on normal birth. However, the growing number of well equipped
				heaith centres including those with maternity beds, does provide an opportunity
				for the midwife to offer primary health care and community based midwifery.
				
						Unfortunately Omani trained nurse
						‐midwives are still few (but growing rapidly) 
						and
				
				maternity services are sustained by expatriate midwives mainly from the Indian
				
						sub
						‐
						continent. These women provide the backbone of maternity care yet most
				
				only have six months ‘midwifery’ training as part of their basic nursing course 
				
						i.e.
				
				the course is really obstetric nursing. 
				In addition obstetric support for midwives is 
				lacking as the number of obstetricians is also reducing and few Omani
				obstetricians are being trained. All Omani obstetricians must be female. Also like
				elsewhere in the world obstetrics is competing with more popular medical
				disciplines. Thus it makes sense for Omani midwives to fulfil the major role in
				maternity service provision.
		
		
				
						With an annual birth rate of approximately 40,500 
						
								(conservative) 
						
						Oman will require
				
				700–1000 Omani midwives to replace the current expatriate workforce and
				provide a safe and comprehensive service. Currently Omani midwives number a
				little in excess of 200 giving a ratio of 1 Omani midwife to 202 births. The public
				perception is that doctors are too quick to perform caesarean sections and so
				women will plan to turn up late in labour to avoid this. 
				Omani midwives know
				that they have to prove themselves and demonstrate to Omani women the value of midwifery as a profession capable of providing maternity care in its own right. They need good role models. Omani midwifery or nursing graduates are not licensed, yet expatriates have tobe licensed with the Nursing and Midwifery Council of Oman. Currently I amworking with others on the setting of Standards and Competencies for  midwifery practice and I aim to persuade the Council that ALL midwives shouldbe licensed and undergo periodic re‐licensure to practise. I am also heavily  involved in a process of converting the current post‐basic diploma to degree status and reinforce the notion that midwifery is not an advanced nursingspecialty but a basic midwifery programme. Iran offers a 4 year direct entrybachelor’s degree programme for midwifery. Hopefully Oman will emulate thatmodel in time.
		
				Despite the obstacles Oman can be proud of its reductions in maternal and
				neonatal mortality: maternal mortality rate is 18.5 per 100,000 live births; the
				stillbirth rate per 1000 births is 8.0 representing a decrease of 107% in 25 years;
				 
				
						and infant mortality is 10.3 per 1000 live births, a decrease of over 1000
						‐
						fold in 30
				
				years. The challenge for the future is further reductions in mortality and 
				prevention of morbidity.
		
		
				In order to provide a comprehensive maternity service the ideal for Oman is for
				
						the service to be midwifery
						‐
						led. However, there is an enormous need for
				
				mentors in this at yet young profession. Midwifery is a gender specific female
				profession, midwives with women, and this relationship is of great importance in
				Oman. It is also essential that the midwifery workforce is Omanised so that
				women benefit from professionals who know and understand the language, the
				
						local circumstances, and traditions. A midwifery
						‐
						led primary health service for
				
				maternity care and health teaching underpinned by progressive midwifery
				education that focuses on the wellbeing of the woman in pregnancy, labour,
				childbirth and the postnatal period, including care of the neonate, where the
				midwife knows her scope of practice, when to refer, and how to manage
				emergencies, is an achievable vision.
		
		
				
						If anyone is interested in further information about midwifery opportunities in Oman please
						contact me at drgillianwhite@yahoo.co.nz
				
				
						Dr. Gillian White
						 
						Professor of Midwifery