Editorial: Integrating continuous support of the traditional birth attendant into obstetric care by skilled midwives and doctors: a cost‐effective strategy to reduce perinatal mortality and unnecessary obstetric interventions

Abstract

In the beginning of 2003 one of the authors (JvR) was privileged to attend a home birth in The Gambia guided by a traditional birth attendant (TBA). The woman was a gravida 2 para 1 and had started labour in the morning. Everybody in the whole compound was anxiously waiting for the child to be born. Nobody (the TBA included) would know whether the baby would be born alive because there was no foetal monitoring whatsoever. The TBA gave continuous emotional support to the woman an evidencebased strategy to improve the outcome of labour. She would have been rather empty-handed had serious complications suddenly occurred. Only in the case of postpartum haemorrhage (PPH) she would be able to administer misoprostol to the woman. In fact the TBA was participating in a randomized trial of misoprostol for the prevention of PPH and although she was illiterate she was able to follow the necessary procedures for the trial. In case of obstructed labour antepartum haemorrhage transverse lie and eclampsia the TBA would have had no tools to deal with these serious complications. Hence TBAs will not have any impact to reduce the appallingly high maternal mortality ratios in the less privileged parts of our global village. TBA practice was therefore considered to be of less value and the international safe motherhood movement started from 1997 onwards to concentrate on skilled attendance during labour and emergency obstetric care when complications would occur. (excerpt)