"We have been working overnight without sleeping": traditional birth attendants' practices and perceptions of post-partum care services in rural Tanzania.

Gladys R Mahiti,Isabel Goicolea,Columba K Mbekenga,Anna-Karin Hurtig,Angwara D Kiwara

doi:10.1186/s12884-015-0445-z

Abstract

BackgroundIn many low-income countries, formal post-partum care utilization is much lower than that of skilled delivery and antenatal care. While Traditional Birth Attendants (TBAs) might play a role in post-partum care, research exploring their attitudes and practices during this period is scarce. Therefore, the aim of this study was to explore TBAs’ practices and perceptions in post-partum care in rural Tanzania.MethodsQualitative in-depth interview data were collected from eight untrained and three trained TBAs. Additionally, five multiparous women who were clients of untrained TBAs were also interviewed. Interviews were conducted in February 2013. Data were digitally recorded and transcribed verbatim. Qualitative content analysis was used to analyze data.ResultsOur study found that TBAs take care of women during post-partum with rituals appreciated by women. They report lacking formal post-partum care training, which makes them ill-equipped to detect and handle post-partum complications. Despite their lack of preparation, they try to provide care for some post-partum complications which could put the health of the woman at risk. TBAs perceive that utilization of hospital-based post-partum services among women was only important for the baby and for managing complications which they cannot handle. They are poorly linked with the health system.ConclusionsThis study found that the TBAs conducted close follow-ups and some of their practices were appreciated by women. However, the fact that they were trying to manage certain post-partum complications can put women at risk. These findings point out the need to enhance the communication between TBAs and the formal health system and to increase the quality of the TBA services, especially in terms of prompt referral, through provision of training, mentoring, monitoring and supervision of the TBA services.

Highlights

In many low-income countries, formal post-partum care utilization is much lower than that of skilled delivery and antenatal care
In many low-income countries, formal post-partum coverage is much lower than skilled delivery coverage and antenatal care coverage [5] even though the promotion of healthy behaviors and care of Mahiti et al BMC Pregnancy and Childbirth (2015) 15:8 the mother and the baby at the community and family levels are important in this period [1,3]
Our study found that Traditional Birth Attendants (TBAs) take care of women during postpartum with rituals appreciated by women

Summary

Introduction

In many low-income countries, formal post-partum care utilization is much lower than that of skilled delivery and antenatal care. The post-partum period – defined by the WHO as the 42 days after childbirth [1]– is an important part in the continuum of care for improving maternal and child health [2,3,4] This period is not as closely monitored and complications to both newborn infant and the mother i.e. Research shows that, in many low-income countries, formal post-partum coverage is much lower than skilled delivery coverage and antenatal care coverage [5] even though the promotion of healthy behaviors and care of Mahiti et al BMC Pregnancy and Childbirth (2015) 15:8 the mother and the baby at the community and family levels are important in this period [1,3]. TBAs cannot be considered skilled birth attendants and the care they provide should not curtail child and maternal mortality and morbidity [13,14,15,16,17,18]

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