The Case for Reorganizing Traditional Birth Attendance

In the face of an inefficient health system, trained TBAs have been seen to be useful in providing efficient, cheap and quality care, counseling, and referral and logistical support, including treatment adherence support. Throughout history traditional birth attendants (TBAs) have been the main human resource for women during childbirth. Their role varies across cultures and at different times, but even today, they attend the majority of deliveries in rural areas of developing countries.

Mama Nkechi, a traditional birth attendant in Nchatancha Community, Enugu.

The big question, “Why do women prefer deliveries with traditional birth attendants against institutional deliveries?” It is an amazing fact that despite the numerous efforts from different government agencies and non-governmental organizations, pregnant women in rural and urban poor areas of developing countries such as Nigeria still resort to non-institutional deliveries. Among these women, it is believed that the TBA’s have a significant role when it comes to cultural competence, consolation, empathy and psychosocial support at birth with important benefits for the mother and also for the new-born child.

In the words of one of the women she said “Mama Nkechi took care of me when I was in labour, she gave me food and tea and comes to the house to bath my baby after delivery. These are the things nurses at the health facility cannot do for me and that is why I prefer to deliver my babies there”. Another woman reported that even when they do not have money to pay their bills after delivery, the TBA’s will always let them go and trust them to pay later.

Now, here are the stories of two traditional birth attendants located in the Enugu sub-urban who have been in the business of delivering babies for decades right in their homes.

  1. Mrs. Getrude Ukeh (aka Mama Nkechi)
    Introduction

Hails from Nkanu Enugu State but lives in Nchatancha Nike Community. A skilled traditional birth attendant who has help women deliver their babies since 1985 with lots of care and empathy. Her kind heart, passion and dedication singled her as the best TBA in her resident community where she also volunteers for a local health care centre. She has SSCE as her highest academic qualification but wishes to enroll for a formal training in midwifery if supported.

2. Mrs. Uzoigwe Anthonia (aka Mama Ebuka)
Introduction
Hails from Nkanu Enugu State but lives in Coal Camp, an area in Enugu metropolis which can best be classified as an urban poor. This God-fearing, kindhearted and gentle traditional birth attendant has devoted her time helping women deliver their babies since 1985. Her passion for maternal and child health has been her drive in her many years of service despite the struggles of keeping up with an inadequate structure as a maternity home. She has SSCE as her highest academic qualification but wishes to gain a formal training in midwifery if supported.


Progress

Prior to the commencement of the anaemia program at the centres, she records about 7 antenatal visits per week with more deliveries monthly. However, since the inception of the anaemia program in December, the rate of attendance has grown by 185.71%. In addition, a formal referral system has been built with a private owned hospital where she can refer her patients to in complicated cases for quick attention.

Recommendation
Following the WHO on health promotion interventions for maternal and newborn health (2015) which states “Where TBAs remain the main providers of care at birth, dialogue with TBAs, women, families, communities and service providers is recommended in order to define and agree on alternative roles for TBAs, recognizing the important role they can play in supporting the health of women and newborns”. It is important to offer basic skill trainings for the TBAs to better equip them for a better support health care.

Conclusion
Training TBAs has been an important component of strategies to improve maternal and neonatal outcomes. The main target of training TBAs is reducing infection, controlling bleeding, and to improve their referral system and network with the formal health care system where fundamental obstetric services are available.

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