Women utilisation, needs and satisfaction with postnatal follow-up care in Oman: A cross-sectional survey.

BACKGROUND: In Oman, there is a lack of data on utilisation, needs and women's satisfaction with care and information provided during postnatal follow-up period. AIM: To investigate postnatal follow-up care utilisation and women's needs; level of postnatal information received and satisfaction with services. METHODS: A purposive sample of women (n = 500), recruited in the immediate postnatal period at one metropolitan and one regional birthing hospital in Oman. An electronic survey link was sent to participants at 6-8 weeks postnatally. Quantitative variables were analysed as frequencies and chi-squared test. RESULTS: A total of 328 completed surveys were received; a response rate of 66 %. Most respondents were located in the metropolitan area (n = 250) and between 20 and 39 years (n = 308). Utilisation was low as women reported no need or no benefit in attending. Women's information needs were not sufficiently met by HCPs, requiring women to seek information from family and the internet to meet their needs. Satisfaction with services was mostly neither satisfied nor dissatisfied (30 %) or satisfied (30 %). CONCLUSION: Postnatal follow-up care utilisation in both metropolitan and regional areas is less than optimal and not utilised as there was no advice to attend or no appointment date/time given, no benefit experienced previously, no need and information needed sourced from family or the internet. The information provided by postnatal follow-up care consumers can be used to enhance service delivery, inform future updates to the national maternity care guidelines, and provides a baseline for future evaluation and research.

Women's Views on Factors that Influence Utilisation of Postnatal Follow-Up in Oman: A descriptive, qualitative study.

Objectives: Postnatal follow-up care (PNFC) is critical for promoting maternal and newborn health and well-being. In Oman, women's utilisation of postnatal follow-up services has declined, with rates as low as 0.29 (mean visits) in some governorates, and fails to meet the recommendation of postnatal follow-up visits at two and six weeks for assessment of the mother and her newborn. The reasons for this low utilisation are not well understood. This study aimed to explore women's views on and identify factors that influence their utilisation of postnatal follow-up services. Methods: Purposive sampling was employed and semi-structured telephone interviews were conducted with 15 women aged 20-39 years at six to eight weeks post-childbirth between May and August 2021. The data were analysed using Erlingsson and Brysiewicz's content analysis approach. Results: The following six categories were identified as influencing PNFC utilisation: 1) need for information; 2) experiences and expectations; 3) family support, expectations and customs; 4) sociocultural beliefs and practice; 5) impact of the COVID-19 pandemic; and 6) the healthcare environment. Influencing factors derived from each category include the need to empower women, provide individualised care, address family and community expectations, offer alternatives to face-to-face clinic visits and provide organised and scheduled appointments. Conclusion: Women in Oman identified the need for consistent information from healthcare providers and a more organised postnatal follow-up service that includes scheduled appointments and a woman-centred approach to PNFC.

Healthcare Providers' Views of Information, Support, and Services Offered to Women in the Postnatal Follow-up Care Period in Oman: A Qualitative Study.

Background: Postnatal care is a component of the maternity care continuum, which is often under-valued and under-offered. The aim of this study was to explore healthcare providers' (HCPs) views about postnatal follow-up care (PNFC) offered to women in Oman. Methods: This qualitative study was performed from May 2021 to January 2022; 29 individual participated in semi-structured telephone interviews with staff nurses (N=20), nurse/midwives (N=5), and doctors (N=4) from Khoula and Ibra hospitals and Al Amerat, Muttrah and Al Qabil health centers in Oman. Conventional content analysis was guided by Erlingsson and Brysiewicz. Results: Seventeen sub-categories and four categories emerged from the data; they included communication and timing of PNFC, provision of PNFC with various components, challenges and needs for providing PNFC, and the impact of COVID-19 on PNFC. Conclusion: Providing postnatal follow-up care in Oman is challenging for HCPs due to lack of clinics dedicated to postnatal care, no scheduled appointment times for women, very limited guidance within the National Maternity Care guideline, and some HCPs (i.e., nurses) with no formal education on the components of postnatal care. These hinder the ability to provide information, education, support, and services to women.

Women's Utilisation, Experiences and Satisfaction with Postnatal Follow-up Care: Systematic literature review.

Postnatal follow-up care is reported to be the 'underutilised' aspect of the maternity care continuum. This review explores women's utilisation of early and late postnatal follow-up and their experiences and satisfaction with it. Five online databases were searched for English or Arabic articles published between 2011 and 2021. Methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool; the Andersen healthcare utilisation model was the framework for data analysis. A total of 19 articles met all inclusion criteria. Utilisation facilitators included complications, travel distance, knowledge of the importance for attending and being offered a telephone call and home visit or clinic visit as options for follow-up. Impediments included lack of perceived need and not being provided with information about postnatal care. Comprehensive discussions with and examination by health providers were reported as positive experiences and influenced repeat utilisation. Dissatisfaction was associated with inconsistent information provided by health providers.

Physiological vital sign reference ranges for well late preterm newborns calculated during a typical 2 h newborn period between 2 h and 7 days of life.

Objectives. To calculate 95% reference ranges for heart rate, respiratory rate, oxygen saturation, temperature and blood pressure for well late preterm newborns between 34+0/7and 36+6/7weeks of gestation during typical neonatal behaviour.Approach.A single-site, prospective cohort study in a major Australian quaternary hospital between February and September 2019. A total of 120 late preterm newborns had their heart rate, respiratory rate and oxygen saturation measurements recorded every 2 s for up to 2 h with unconditional 95% reference ranges determined using a linear mixed effects model with random intercept for total standard deviation calculation including repeated measures. Temperature and blood pressure measurements were collected twice-at the start and conclusion of the data recording period-with weighted 2.5th and 97.5th percentiles calculated using the mean value.Main results.A total of 364 577 heart rate, 365 208 respiratory rate, 360 494 peripheral oxygen saturation and 240 temperature and blood pressure values were obtained. The 95% reference ranges were: heart rate 102-164 bpm; respiratory rate 15-67 rpm; oxygen saturation 94%-100%; temperature 36.4 °C-37.6 °C; systolic blood pressure 51-86 mmHg; diastolic blood pressure 28-61 mmHg; mean arterial pressure 35-68 mmHg.Significance.Seven vital sign reference ranges were reported for the late preterm population during a typical newborn period (such as crying, sleeping, feeding, awake and alert, and during nappy hygiene cares); internal and external validation should be completed prior to clinical use. Cut off points for escalation of care have previously been generalised to all newborns irrespective of gestational age, which may result in over-treatment or a delay in recognising subtle signs of deterioration.

Physiological vital sign ranges in newborns from 34 weeks gestation: A systematic review.

CONTEXT: The birth process and the moments thereafter are a crucial time for newborns as they adapt to extra uterine life. The adaptive process begins immediately and can take a number of days to complete. The process involves initiating and maintaining respirations, thermoregulation, and the change from foetal circulation to newborn circulation. The majority of newborns successfully adapt to extra uterine life, some experience difficulty. Early warning tools may assist clinicians identify early signs of failure to adapt and/or deterioration but these are dependent on 'Normal' vital sign reference ranges for triggering an escalation of care. Age-matched early warning tools may improve the sensitivity of tools. OBJECTIVE: To identify physiological vital sign reference ranges for newborns ≥34 weeks gestation from two hours of age. DESIGN: Systematic Review. DATA SOURCES: Between August 2016 and January 2017, PubMed, CINAHL, Embase, The Cochrane Library databases, and conference abstracts were searched for primary studies published between 1946 and 2017. Reference lists of retrieved articles were reviewed for potential studies. REVIEW METHODS: Primary studies published in English that reported physiological vital sign reference ranges pertaining to well newborns born from 34 weeks gestation were selected. Two authors independently assessed eligibility of studies for inclusion. Titles and abstracts were matched with the inclusion criteria: studies investigating heart or respiratory rate, temperature, blood pressure and oxygen saturations in well newborns greater than 34 weeks gestational age. Assessment of quality and grading of level of evidence were assessed using National Health and Medical Research Council level of Evidence Hierarchy Table and the Quality Assessment Tool for Quantitative Studies. Any disagreements were resolved by consensus. Data were extracted by two reviewers. RESULTS: A total of 1497 primary studies were retrieved. Following screening and removal of duplicates and screening, 10 primary studies investigating heart rate (n=1), respiratory rate (n=1), temperature (n=1), blood pressure (n=4) and oxygen saturations (n=3) were eligible for inclusion in this review. The populations studied included term (n=6) or both preterm and term newborns (n=4). No reference ranges for any vital sign measurements could be identified from the included literature. In addition, inconsistencies between vital sign parameters of newborns were identified between the studies. CONCLUSION: There is paucity of normal vital sign data in the late preterm >34 weeks and post term gestational age cohorts despite literature suggesting differences in physiological maturity between these cohorts.

Neonatal Early Warning Tools for recognising and responding to clinical deterioration in neonates cared for in the maternity setting: A retrospective case-control study.

BACKGROUND: All newborns are at risk of deterioration as a result of failing to make the transition to extra uterine life. Signs of deterioration can be subtle and easily missed. It has been postulated that the use of an Early Warning Tool may assist clinicians in recognising and responding to signs of deterioration earlier in neonates, thereby preventing a serious adverse event. OBJECTIVE: To examine whether observations from a Standard Observation Tool, applied to three neonatal Early Warning Tools, would hypothetically trigger an escalation of care more frequently than actual escalation of care using the Standard Observation Tool. DESIGN: A retrospective case-control study. SETTING: A maternity unit in a tertiary public hospital in Australia. METHODS: Neonates born in 2013 of greater than or equal to 34(+0) weeks gestation, admitted directly to the maternity ward from their birthing location and whose subsequent deterioration required admission to the neonatal unit, were identified as cases from databases of the study hospital. Each case was matched with three controls, inborn during the same period and who did not experience deterioration and neonatal unit admission. Clinical and physiological data recorded on a Standard Observation Tool, from time of admission to the maternity ward, for cases and controls were charted onto each of three Early Warning Tools. The primary outcome was whether the tool 'triggered an escalation of care'. Descriptive statistics (n, %, Mean and SD) were employed. RESULTS: Cases (n=26) comprised late preterm, early term and post-term neonates and matched by gestational age group with 3 controls (n=78). Overall, the Standard Observation Tool triggered an escalation of care for 92.3% of cases compared to the Early Warning Tools; New South Wales Health 80.8%, United Kingdom Newborn Early Warning Chart 57.7% and The Australian Capital Territory Neonatal Early Warning Score 11.5%. Subgroup analysis by gestational age found differences between the tools in hypothetically triggering an escalation of care. CONCLUSIONS: The Standard Observation Tool triggered an escalation of care more frequently than the Early Warning Tools, which may be as a result of behavioural data captured on the Standard Observation Tool and escalated, which could not be on the Early Warning Tools. Findings demonstrate that a single tool applied to all gestational age ranges may not be effective in identifying early deterioration or may over trigger an escalation of care. Further research is required into the sensitivity and specificity of Early Warning Tools in neonatal sub-populations.