Global Forum, Day 5

For the online discussion, click here.
Optimizing the roles of health workers to improve MDGs 4 and 5 discussion forum.

Today's question:

“If Traditional Birth Attendants are available, what practices or tasks should they undertake to reduce maternal and neonatal mortality and morbidity?”

Jane Otai, Kenya, responded:

TBA have in the past delivered mothers and thus the name traditional birth attendants.They are untrained and use crude methods in delivering mothers leading to high maternal and neonatal deaths. However, they are very important in communities and are indeed trusted. TBA role in the communities should be to encourage mother to attend ANC, advice on FP, educate the community on various health related issues and participate in community mobilization for health. In Kenya, we realised that they influence decisions on where the birth should take place and now we are calling them birth companions. In this role they escort the mother to the health facility, rub her back when she needs it and offer hot tea. In this way they accepted to be part of the company that helps in birthing the new born instead of getting them to practice in secret. Another important role would be to care for the new born. This requires training of the TBA so that they adopt good practices.

Similar responses have been received from other participants in Africa and India and Pakistan. There seems to be disagreement about what is a traditional birth attendant, but several respondants linked the TBA to home birth in developing countries.

My comments:

A friend of mine, a midwife, spent time with MSF in several African countries.  She told me that traditional practices in villages included induction of labour by packing leaves from specific local plants that have a uterotonic effect into the vagina at the time when it was determined that the baby was 'due'.  This is possibly one of the practices that would be considered 'crude', leading to problems for mothers and babies.

Midwives in our country will sometimes have specific practices that have been handed down over the generations, or possibly adopted from other traditions.  Some midwives encourage women to place cloves of garlic in their vaginas to prevent or treat group B Streptococcal infection.   There are some doctors and midwives who will recommend enemas or bowel washouts in early labour to move things on.  This traditional practice has probaby been a remnant from days when a 'clean' bowel meant everything was right with the world.

Many traditional practices to do with the care of the newborn baby in the first few days of life are of note here as being unsupportable and possibly dangerous.  Many traditions have withheld the colostrum from the newborn, believing it to be dirty.  The upholders of this sort of tradition have been the midwives and birth attendants.  Women in some middle-Eastern and African countries have supported and promoted the practice of female genital mutilation, considering it to be a traditional practice.

I am not aware of anyone who could be called a TBA in Australia. I understand that there are unregistered birth attendants who will accept invitations to home births without a midwife in attendance. These women do not seem to have any traditional body of knowledge. Rather, they have gleaned bits of midwifery knowledge and fragmented skill without an intellectual framework that can only be achieved with systematic learning and critical reflection.   The observance of ritual without peer review or being subjected to any standards or regulation is not supportable in today's world.