Traditional Birth Attendants and Mothers
What is a Traditional Birth Attendant?
"A traditional birth attendant (TBA), also known as a traditional midwife, community midwife or lay midwife, is a pregnancy and childbirth care provider.
Traditional midwives provide basic health care, support and advice during and after pregnancy and childbirth, based primarily on experience and knowledge acquired informally through the traditions and practices of the communities where they originated. TBAs do not receive formal education and training in health care provision, and there are no specific professional requisites such as certification or licensure. They often learn their trade through apprenticeship or are self-taught; in many communities one of the criteria for being accepted as a TBA by clients is experience as a mother." [30][31]
The Traditional Birth Attendant-Mother Relationship
A group of caregivers that often assist with deliveries in Uganda is the Traditional Birth Attendant (TBA). TBAs are not formally educated in the sense that midwives are, but they have likely been instructed by experienced TBAs in the community. Of the 100 women I surveyed, 27% in the rural area and 3% in the urban area had been delivered by TBAs for at least one of their previous deliveries. The distinction between midwife and TBA is not as clear in every culture as it is in Uganda. In other cultures, these are one and the same person. After conducting research on dais (a type of birth attendant in India), Susan Pinto remarks that,
“Beyond India, the ‘traditional midwife’ is… like the dai, romanticized and vilified, symbolic of the timelessness of non-western peoples and ‘tradition’ in general, and axiomatic of where women stand in ascension of development. In many public health literatures the ‘traditional midwife’ becomes the ‘traditional birth attendant,” the ‘TBA,’ and serves as either a resource for social transformation or the accumulation of all that is dangerous about certain ways of thinking and doing.” [32]
As Pinto discusses, the notion of the TBA is highly controversial. While midwives are generally recognized as adequately trained caregivers, the qualifications of a TBA are variable and may present a hazardous situation for mothers in labor. While some TBAs are knowledgeable concerning hygienic delivery procedures, others may not be, especially when an emergency situation occurs. However, many women, especially in developing countries prefer to deliver their babies in the comfort of their own home, with the assistance of a TBA with which they share trusting relationship.
Sandra Anderson, M.S., R.N. and Eleanor Bauwens Ph.D., R.N., F.A.A.N. initiated a research project in the United States to determine some of the possible reasons for the women’s preference to deliver at home instead of at a hospital. While they researched women in the United States, similar reasons most likely exist in other cultures as well. Anderson and Bauwens assert that women are interested in delivering inside the home “because they [believe] that birth is a normal and natural process best left alone or to the gentle guidance of helpers willing to support the mother and ‘catch’ the baby.” [33] One of the main issues with delivering babies at home is the presence (or lack of) a person who is qualified to deliver babies. While uncomplicated deliveries require little specialized knowledge, the slightest complication could be fatal if not handled in the correct manner by someone who has been educated about maternal and newborn health. Anderson and Bauwens suggest that “nurse midwives are a potential group of practitioners who can meet this need for an attendant at a home birth.” [34]
The idea that some mothers wish to deliver at home is not unique to the United States. In fact it is much more prevalent in developing countries, such as Uganda, where most women choose to deliver at home. [35] Therefore, there is an even higher demand for these “nurse midwives” outside of the United States. While this demand is being met by figures such as TBAs in Uganda, these figures are not as qualified as trained nurses and midwives. In order to improve maternal and newborn healthcare in countries such as Uganda, TBAs must be educated to the same level as midwives.
"A traditional birth attendant (TBA), also known as a traditional midwife, community midwife or lay midwife, is a pregnancy and childbirth care provider.
Traditional midwives provide basic health care, support and advice during and after pregnancy and childbirth, based primarily on experience and knowledge acquired informally through the traditions and practices of the communities where they originated. TBAs do not receive formal education and training in health care provision, and there are no specific professional requisites such as certification or licensure. They often learn their trade through apprenticeship or are self-taught; in many communities one of the criteria for being accepted as a TBA by clients is experience as a mother." [30][31]
The Traditional Birth Attendant-Mother Relationship
A group of caregivers that often assist with deliveries in Uganda is the Traditional Birth Attendant (TBA). TBAs are not formally educated in the sense that midwives are, but they have likely been instructed by experienced TBAs in the community. Of the 100 women I surveyed, 27% in the rural area and 3% in the urban area had been delivered by TBAs for at least one of their previous deliveries. The distinction between midwife and TBA is not as clear in every culture as it is in Uganda. In other cultures, these are one and the same person. After conducting research on dais (a type of birth attendant in India), Susan Pinto remarks that,
“Beyond India, the ‘traditional midwife’ is… like the dai, romanticized and vilified, symbolic of the timelessness of non-western peoples and ‘tradition’ in general, and axiomatic of where women stand in ascension of development. In many public health literatures the ‘traditional midwife’ becomes the ‘traditional birth attendant,” the ‘TBA,’ and serves as either a resource for social transformation or the accumulation of all that is dangerous about certain ways of thinking and doing.” [32]
As Pinto discusses, the notion of the TBA is highly controversial. While midwives are generally recognized as adequately trained caregivers, the qualifications of a TBA are variable and may present a hazardous situation for mothers in labor. While some TBAs are knowledgeable concerning hygienic delivery procedures, others may not be, especially when an emergency situation occurs. However, many women, especially in developing countries prefer to deliver their babies in the comfort of their own home, with the assistance of a TBA with which they share trusting relationship.
Sandra Anderson, M.S., R.N. and Eleanor Bauwens Ph.D., R.N., F.A.A.N. initiated a research project in the United States to determine some of the possible reasons for the women’s preference to deliver at home instead of at a hospital. While they researched women in the United States, similar reasons most likely exist in other cultures as well. Anderson and Bauwens assert that women are interested in delivering inside the home “because they [believe] that birth is a normal and natural process best left alone or to the gentle guidance of helpers willing to support the mother and ‘catch’ the baby.” [33] One of the main issues with delivering babies at home is the presence (or lack of) a person who is qualified to deliver babies. While uncomplicated deliveries require little specialized knowledge, the slightest complication could be fatal if not handled in the correct manner by someone who has been educated about maternal and newborn health. Anderson and Bauwens suggest that “nurse midwives are a potential group of practitioners who can meet this need for an attendant at a home birth.” [34]
The idea that some mothers wish to deliver at home is not unique to the United States. In fact it is much more prevalent in developing countries, such as Uganda, where most women choose to deliver at home. [35] Therefore, there is an even higher demand for these “nurse midwives” outside of the United States. While this demand is being met by figures such as TBAs in Uganda, these figures are not as qualified as trained nurses and midwives. In order to improve maternal and newborn healthcare in countries such as Uganda, TBAs must be educated to the same level as midwives.