Traditional Birth Attendants

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]

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]

The shortage of trained health professionals is among the main obstacles to strengthening low-income countries health systems and to scaling up HIV/AIDS control efforts. Traditional health practitioners are increasingly depicted as key resources to HIV/AIDS prevention and care. An appropriate and effective response to the HIV/AIDS crisis requires reconsideration of the collaboration between traditional and biomedical health providers (THPs and BHPs). The aim of this paper is to explore biomedical and traditional health practitioners experiences of and attitudes towards collaboration and to identify obstacles and potential opportunities for them to collaborate regarding care for patients with sexually transmitted infections (STIs) and HIV/AIDS. [author’s description]

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]

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.

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]

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]

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.

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]

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]

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.

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]

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.

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]

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.

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]

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]

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 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]

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 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]