The relevance of traditional birth attendants

Despite efforts by government and non-governmental organisations to make women go to the hospital to give birth, a number of pregnant women especially in the rural areas still abhor going to the hospital. Till date, it takes threat of serious complications before some families agree to allow their pregnant women to go hospital. In the […]

Despite efforts by government and non-governmental organisations to make women go to the hospital to give birth, a number of pregnant women especially in the rural areas still abhor going to the hospital.
Till date, it takes threat of serious complications before some families agree to allow their pregnant women to go hospital.
In the northern part of  the country, locally trained traditional birth attendants may have assumed an ‘indispensable’ type of status and reckoning.
Some women who spoke on the issue said they prefer traditional birth attendants because they cannot imagine themselves going to the hospital where they may have to expose their bodies to male medical workers.
“As married women, we don’t wish to be naked with our legs wide apart for a male to come and start touching our bodies in the name of a birth attendant,” one of them, who is a mother of five stated.
She said she had all her children at home with the aid of a TBA.
A 60 year old local traditional birth attendant, Malama Hawa’u said despite the advent of  modern techniques, women still prefer their services.
“We are the first port of call concerning birth cases and we are still a force  to reckon with  because some of the modern trained birth attendants  have  the same local outfits and they still use some of the old school techniques to deliver a pregnant woman,” she claimed.
Malama Hauwa’u said people call on them at odd hours and they are still busy going from one house to another operating alongside the modern trained TBAs.
“The trained colleagues don’t pose any threat to our survival and we are equally ready to use modern techniques when and where necessary since we also refer cases to hospitals when we fail to control them,” Hauwa’u stated.
She said they still use a razor blade to cut the umbilical cord, warm water to clean both the mother and her child and that where they experience some difficulties, they resort to herbs and concoctions.
She however stressed: “Any labour that goes beyond an hour has to be referred to hospital for medical intervention especially where it is available and easy to access.”
Hauwa’u called on government to consider establishing adequate TBA training centres across the 23 local government areas of the state especially in hard-to-reach areas in order to make their services available, and also curtail the menace of maternal mortality among pregnant women.
However, with the support of  the United States Agency for International Development (USAID)  funded Target States High Impact Programme, TSHIP which aimed at strengthening health care delivery in the state, Sokoto  is noted to have recorded some improvement in the number of deliveries with skilled attendants.
In a recent review of the TSHIP project which was launched in 2009, it was noted to have achieved  172 percent increase in the number of deliveries with a skilled attendants  between 2010 and 2014 and a  decrease in percentage of women in Sokoto who deliver alone from 25% in 2008 to less than 1% in 2013,among others.
Before the launch of the programme, statistics had shown that about 95.3percent of women in Sokoto deliver at home.
Under the TSHIP project, 2,440 community Based Health volunteer, CBHVs, 10 each from the  244 wards in the state, were identified and trained to promote positive health seeking behaviours.
Fatima Ahmed,50, of Dambuwa village, Dange Shuni Local Government Area, Sokoto State ,who is one of those trained under  TSHIP project , has been  in  the programme since 2013.
“We’re a volunteer category of birth attendants who the communities patronize more than the hospitals until TSHIP approached us for training and subsequently partnership. We received training at the local government headquarters for seven days and were given a bag containing all the modern necessary materials for attending to a pregnant woman who wants to give birth,” she explained.
Fatima said the materials included books for both record keeping and guide to safe delivery, hand gloves, misoprostol tablets for control of excessive bleeding after  delivery ,towels, thread for tying of umbilical cord, malaria drugs as well as antiseptic soaps and ointments.
“Our approach  involves opening a register for a pregnant woman where we record her progress until she gives birth and we also encourage them to go for antenatal visits to hospitals to safeguard against complications. During our weekly visits to pregnant women, we encourage hygienic living and decent way of keeping our family happy and free from illness,” she stated.
She added: “We continue monitoring our clients until the time  a woman  gives birth when we deliver her at home and escort her to nearby hospital to be received by professional hands.”
Fatima said the coming of TSHIP has assisted in curtailing the rate of maternal mortality among pregnant women through regular contact with trained birth attendants.
“It takes a long time before you hear  cases of death during labour,” she said.
To keep them abreast with modern techniques of child delivery, Fatima said they attend meetings at selected clinics where they refresh their knowledge, exchange ideas, share experiences and learn new approaches.
She said: “Where there are unique challenges and problems, we collectively discuss them and try to solve them. To make our services more effective and relevant, we invite local TBAs to join the modern approach and gradually all the ones in my community are responding to the call.”
According to her, the efforts of the TSHIP trained birth attendants have been encouraging pregnant women to go for antenatal visits and even to give birth at hospitals. She added that that many women no longer look at hospital as a place where they expose their nakedness to male medical personnel.
She asserted: “We are trying to sanitize the services by doing away with the local way which is not safe and contributing to many complications especially in rural areas. The local TBAs who make use of unsterilized objects, herbs and concoctions to deliver pregnant women, should be a thing of the past.”