Skilled Attendance

Use Pattern of Maternal Health Services and Determinants of Skilled Care During Delivery in Southern Tanzania: Implications for Achievement of MDG-5 Targets

The objective of this study was to assess the use determinants of skilled attendants at delivery in Mtwara rural district. The information obtained will help the district health management team to develop interventions to improve use of delivery care services and ultimately achieve the millennium goal to reduce the high rates of maternal mortality. [from author]

Revisiting the Exclusion of Traditional Birth Attendants from Formal Health Systems in Ethiopia

Traditional birth attendants have been a subject of discussion in the provision of maternal and newborn health care, especially in developing countries where there is a lack of infrastructure and trained health personnel. The objective of this study was to assess the role of trained traditional birth attendants in maternal and newborn health care in Afar Regional State. [from abstract]

Human Resource Strategy Options for Safe Delivery

This report examines the current and future availability of skilled health workers for safe delivery services and the factors influencing their retention in government health facilities, particularly in rural areas of Nepal. [from author]

Reduced Perinatal Mortality Following Enhanced Training of Birth Attendants in the Democratic Republic of Congo: A Time-Dependent Effect

The purpose of this study was to evaluate the effect on perinatal mortality of training birth attendants in a rural area of the Democratic Republic of Congo using two established programs. [from abstract]

Delivery Practices and Associated Factors among Mothers Seeking Child Welfare Services in Selected Health Facilities in Nyandarua South District, Kenya

This study aimed at establishing delivery practices among selected mothers seeking child welfare services at selected health facilities in Nyandarua South district, Kenya, to determine the proportions of deliveries attended by skilled birth attendants as well the factors influencing the mothers’ choices. [from introduction]

Use of Midwives and Traditional Birth Attendants in HIV Care

The authors provide an overview of maternal health services in the context of the HIV pandemic and outline the role of health professionals in maternal health and HIV prevention, care, and treatment. Particular attention is paid to the potential role of traditional birth attendants in expanding access to quality care. [adapted from author]

Training Program for Birth Attendance Reduces Neonatal and Perinatal Mortality in Zambian Clinics

A birth attendant training program that has been shown in a multinational trial to reduce stillbirth and perinatal mortality rates among neonates weighing at least 1.5 kilograms - most of them born outside of hospitals, also reduced mortality among infants of all weights born in Zambian clinics. [from author]

Systematic Review on Human Resources for Health Interventions to Improve Maternal Health Outcomes: Evidence from Developing Countries

This review focuses on the impact of HRH interventions on health care professionals defined as skilled birth attendants to decrease maternal mortality and morbidity. It derives lessons, gaps and recommendations based on the studies conducted on HRH implementations in developing countries. [adapted from author]

Experience of Being a Traditional Midwife: Relationships with Skilled Birth Attendants

This article focuses on an unexpected finding of a research project which explored the experience of being a traditional midwife. The study found that traditional midwives often perceive skilled (professional) birth attendants to be abusive of both them and the women who are transferred to hospital for emergency obstetric care. [from abstract]

Traditional Birth Attendants Lack Basic Information on HIV and Safe Delivery Practices in Rural Mysore, India

There is little research on HIV awareness and practices of traditional birth attendants (TBA) in India. This study investigated knowledge and attitudes among rural TBA in Karnataka as part of a project examining how traditional birth attendants could be integrated into prevention-of-mother-to-child transmission of HIV programs in India. [from abstract]

Entry into this World: Who Should Assist? Birth Attendants and Newborn Health

The period of birth is critical in the life of the mother and the baby. Ideally, it needs to be assisted in a competent manner by a skilled birth attendant (SBA) supported by an enabling environment. This goal has yet to be achieved in all countries. It is essential to upgrade the skills of existing SBAs in managing both the mother and baby, and to supply the necessary resources. Another key strategy is to implement suitable community-based interventions to achieve the required behaviors in family members, health workers, and volunteers to improve newborn health. [abstract]

Skilled Birth Attendants

This factsheet discusses the roles, resposibilities and impact on maternal mortality of skilled birth attendants.

Impact of Oportunidades on Skilled Attendance at Delivery in Rural Areas

The objective of this paper is to assess the impact of Oportunidades (Human Development Program)on skilled attendance at delivery in rural areas through the application of a variety of evaluation techniques, taking advantage of the experimental design implemented for the evaluation of this program in rural areas. [from introduction]

High ANC Coverage and Low Skilled Attendance in a Rural Tanzanian District: a Case for Implementing a Birth Plan Intervention

This study contends that increasing coverage of skilled delivery care and achieving the full implementation of Tanzania’s Focused Antenatal Care Package in Ngorongoro depends upon improved training and monitoring of health care providers, and greater family participation in antenatal care visits. [adapted from abstract]

Use of Traditional and Complementary Health Practices in Prenatal, Delivery and Postnatal Care in the Context of HIV Transmission from Mother to Child (PMTCT) in the Eastern Cape, South Africa

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]

Traditional Birth Attendants in Rural Nepal: Knowledge, Attitudes and Practices about Maternal and Newborn Health

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]

Potential Role of Traditional Birth Attendants in Neonatal Healthcare in Rural Southern Nepal

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]

Participation of Traditional Birth Attendants in Prevention of Mother-to-Child Transmission of HIV Services in Two Rural Districts in Zimbabwe: a Feasibility Study

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]

Taking Critical Services to the Home: Scaling-Up Home-based Maternal and Postnatal Care, Including Family Planning, through Community Midwifery in Kenya

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]

Persistence and Challenges of Homebirths: Perspectives of Traditional Birth Attendants in Urban Kenya

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]

Effectiveness of the TBA Program in Reducing Maternal Mortality and Morbidity in Malawi

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]

Practices of Rural Egyptian Birth Attendants During the Antenatal, Intrapartum and Early Neonatal Periods

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]

Inequity in Maternal Health Care Services: Evidence from Home-Based Skilled Birth Attendant Programmes in Bangladesh

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]

Intervention Involving Traditional Birth Attendants and Perinatal and Maternal Mortality in Pakistan

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]

Indian Public-Private Partnership for Skilled Birth-Attendance

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]

Are Skilled Birth Attendants Really Skilled? A Measurement Method, Some Disturbing Results and a Potential Way Forward

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]

Recognition of High Risk Pregnancies and Referral Practices Among Traditional Birth Attendants in Mkuranga District, Coast Region, Tanzania

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.

Swaziland's Traditional Birth Attendants Survey

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]

Strengthening Midwife-Hilot Partnership to Improve Maternity and Newborn Care Services in ARMM

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]

Low Use of Skilled Attendants' Delivery Services in Rural Kenya

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]