Skilled Attendance

The aim of this study was to provide a baseline assessment in PMTCT in the traditional health sector to determine the views of women who have used the services of traditional practitioners before, during and/or after pregnancy; and to conduct formative research with traditional health practitioners (THPs), i.e. herbalists, diviners and traditional birth attendants on HIV, pregnancy care, delivery and infant care. [adapted from abstract]

Efforts to formalize the role of traditional birth attendants (TBAs) in maternal and neonatal health programmes have had limited success. Continued attendance by TBAs at home deliveries suggests the potential to influence maternal and neonatal outcomes. The objective of this qualitative study was to identify and understand the knowledge, attitudes and practices of TBAs in rural Nepal. [adapted from abstract]

The potential for traditional birth attendants (TBAs) to improve neonatal health outcomes has largely been overlooked during the current debate regarding the role of TBAs in improving maternal health. Randomly selected TBAs were interviewed to gain a more thorough understanding of their knowledge, attitudes, and practices regarding maternal and newborn care. [from abstract]

Prevention of Mother-to-Child Transmission of HIV is among the key HIV prevention strategies in Zimbabwe. The main objective of this study was to evaluate acceptability and feasibility of reinforcing the role of traditional birth attendants (TBAs) in family and child health services through their participation in PMTCT programmes in Zimbabwe. [from abstract]

Increasing access to safe delivery and family planning services within rural communities increases the opportunities for women to have positive outcomes for their pregnancies as well as to plan and achieve their desired family size. This paper examines the scaling up of a community-based model in Kenya that enabled women to give birth safely at home or to be referred to a hospital when attended by a self-employed skilled midwife living in the community. [adapted from summary]

Through an analysis of focus group discussion data, we examine Kenyan traditional birth attendants’ accounts of the persistence of homebirths and the key challenges they present. [from abstract]

The main objective of this study was to assess the role of traditional birth attendants and the quality of their services in contributing to the reduction of maternal deaths in Malawi. [from abstract]

While previous Egyptian studies have identified provider practices contributing to maternal mortality, none has focused on neonatal care. This report details a survey of reported practices of birth attendants. As well, 217 recently-delivered mothers in rural areas of three governorates were interviewed about antenatal, intrapartum and postnatal care they received. [from abstract]

The objective of this research is to explore inequities in utilization of skilled attendance at birth, delivery by caesarean sections and use of postnatal care services, by key socioeconomic factors in two home-based SBA areas of Bangladesh to provide insights for future programming. [from introduction]

This article describes an intervention for training traditional birth attendants and integrating them into an improved health care system, which was proven to be achievable and effective in reducing perinatal mortality. This model could result in large improvements in perinatal and maternal health in developing countries. [adapted from abstract]

This article describes the efforts of the Indian government to decrease maternal mortality by improving birthing conditions. The scheme created a partnership with the private sector and an NGO to provide free birth care to poor families through contracts with private obstetricians practicing in rural areas. The authors conclude that public-private partnerships can rapidly scale up the availability of human resources for skilled birth-attendance and emergency obstetric care to the poor in a very short time. [adapted from author]

Delivery by a skilled birth attendant (SBA) serves as an indicator of progress towards reducing maternal mortality worldwide – the fifth Millennium Development Goal. Though WHO tracks the proportion of women delivered by SBAs, we know little about their competence to manage common life-threatening obstetric complications. We assessed SBA competence in five high maternal mortality settings as a basis for initiating quality improvement. [from abstract]

A cross-sectional study was carried out in Mkuranga District of Tanzania with the aim of comparing the ability of trained and untrained traditional birth attendants (TBAs) in identifying women with danger signs for developing complications during pregnancy and childbirth as well as their referral practices. Study findings revealed that majority of the TBAs (86.5%) had not received any training. Trained TBAs were more knowledgeable on danger signs during pregnancy and childbirth and were more likely to refer women with complications to a health facility, compared to untrained TBAs. The authors recommend that in resource constrained countries like Tanzania and especially in remote rural areas, TBAs should be trained on early identification of mothers with obstetrical complications and on their prompt referral to health facilities that can provide emergency obstetric care.

The Traditional Birth Attendants (TBAs) Survey in Swaziland was undertaken between March 27th 1996 and April 8th 1996. The objective of the survey was to generate reliable information regarding activities of TBAs in Swaziland. The survey was conducted in 25 Chiefdoms sampled out of a total of 206 Chiefdoms registered in Swaziland. [from abstract]

This article discusses a program that established primary health centers in remote villages and trained literate women in these villages as birth attendants to offer antenatal care, low-risk delivery, and triage of high-risk mothers to larger health facilities. In 2002, the birth attendants were trained to provide Prevention of Maternal-to-Child HIV Transmission (PMTCT) services, including counseling, voluntary testing, performing oral rapid HIV tests, posttest counseling, and administering single-dose nevirapine to HIV-positive women, to be taken in labor, and to their newborns. Ongoing supervision is provided by nurse supervisors. [adapted from abstract]

This model for strengthening the midwife and hilot partnership was developed to improve the quality and accessibility of maternity and newborn care services (MNCS) in the Autonomous Region in Muslim Mindanao (ARMM). It aims to provide quality MNCS at various service settings like the home, community and health facilities. [introduction]

The aim of the study was to estimate the use of skilled attendants’ delivery services among users of antenatal care and the coverage of skilled attendants’ delivery services in the general population in Kikoneni location, Kenya. Antenatal care attendance, deliveries by skilled attendants, and the percentage of antenatal care attendees who delivered in a healthcare facility were assessed. Targeted programmatic efforts are necessary to increase skilled attendant-assisted births, with the ultimate goal of reducing maternal mortality. [from abstract]

This document provides a brief history of training of traditional birth attendants (TBAs), summary of evidence for effectiveness of TBA training, and consideration of the future role of trained TBAs in an environment that emphasizes transition to skilled birth attendance. [adapted from abstract]

Recent efforts to improve maternal health have focused on skilled attendants and emergency care at health facilities. Skilled birth attendants and access to emergency obstetric care are essential to saving mothers lives. In developing countries, 60 million women give birth at home without skilled care and with high maternal and neonatal mortality. Nearly all essential newborn care can be provided safely, effectively, and at a low cost at the household level. The same is true for care of the mother, and many effective interventions can be implemented at the household and community level that will save mothers’ lives.

Many women choose to use traditional birth attendants in Guatemala to deliver their babies - a fact that can’t be ignored, according to local public-health officials. They hope a new culturally sensitive approach to training traditional birth attendants will help improve their quality of care and save lives. [adapted from author]

This report presents the results from Rwanda for the of the Quality Assurance Project’s three Safe Motherhood Studies: competence of skilled birth attendants, the enabling environment for skilled attendance at birth, and the causes of the delay in receiving medical attention after a woman arrives at a healthcare facility. The Rwanda study focused on an urban referral (tertiary care) hospital with an active maternity department, two mid-sized referral (secondary care) hospitals, and four health centers. [publisher’s description]

Through its Safe Motherhood Research Program, the Quality Assurance Project carried out three studies to explore issues regarding competence of skilled birth attendants, the elements that contribute to an enabling environment and the causes of the delay in receiving medical attention after a woman arrives at a healthcare facility in countries with high maternal mortality ratios.

An NSDP survey shows strong support for the use of skilled birth attendants and willingness to pay for their services. Widespread use of SBAs holds much promise in helping to meet the UN Millennium Development goal of reducing the maternal mortality rate to around 140 by 2015. The survey results, which also indicate some barriers to SBA use, have enabled the design of an appropriate pilot intervention. [from introduction]

The objective of this study was to describe the profile of community health workers - health promoters, traditional birth attendants and traditional healers - in rural Quechua communities from Ayacucho, Peru.

In issuing this statement, WHO, ICM and FIGO are advocating for skilled care during pregnancy, childbirth and the immediate postnatal period. This statement is especially aimed at countries in which the coverage of skilled attendance at birth is below 85%. The statement defines clearly who is a skilled attendant, what skills she/he should have and how she/he should be trained and supported. Thus a skilled attendant is an accredited health professional — such as a midwife, doctor or nurse — who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns.

An editorial arguing for expanding the professional category of the formal health care workers to include home-based informal caregivers, political community leaders, shop vendors of health products, and traditional health practitioners. The editorial further notes that formal health workers can become informal health workers when operating outside the rules of the health system.

Every year a million women infected with HIV deliver babies without professional help. This article suggests that traditional birth attendants could be involved in preventing perinatal transmission of HIV by offering services such as HIV testing and counseling and short courses of antiretroviral drugs. [publisher’s description]