Background to the study
Skilled attendants at birth are a proven intervention to improved maternal and newborn health outcomes. In many developing countries where there is often a shortage of trained biomedical personnel, maternal care is usually provided by Traditional Birth Attendants World Health Organization (WHO, 2010). One key intervention to improve maternal health is to ensure that all women have access to skilled care during labour and delivery, unfortunately, less than 40% of Nigerian women give birth with a skilled attendant, this suggest that over 60% of Nigerian women are at excess risk of maternal death, as they do not have access to or utilize available lifesaving services (Graham, Bill &Bullough, 2009).Throughout history, TBAs have been the main human resource for women during childbirth, their role varies across cultures and times but even today, they attend to the majority of deliveries in the rural areas of developing Countries (Imogie,2012).Traditional birth attendants are accessible, culturally acceptable and are known to influence women’s decisions about using their health care. World Health Organization (WHO, 2005).There is little doubt that they have a significant role when it comes to cultural competence and psychosocial support at birth, all of which are important benefit for the woman and also the newborn baby (Falle, Mullany & Thatte,2009).WHO,(2012) observes that, TBAs can potentially improve maternal and newborn health at community level and while the role of TBAs in caring for pregnant women & conducting deliveries is acknowledged, they are generally not trained. Traditional Birth Attendants (TBAs) have varying definitions across the globe. World Health Organization further reports that traditional birth attendants and community midwives have a key role to play in midwifery practice. They are often the only available source of basic prenatal care and family planning services in isolated communities, and are generally the main source of help in pregnancy and childbirth. They are highly respected members and proven asserts in addressing poor maternal outcomes (Mac-Arthur, 2009).Studies in developing countries such as Bangladesh, Turkey, South Asia and Nigeria revealed that Traditional birth attendants are generally older, non-literate women who have learnt the care of pregnant women, delivery and postpartum care through apprenticeship (Fatmi, Gulzer, &Kazi, 2005).
The TBAs consider themselves to be the private practitioners who respond to request for services, TBAs receive some compensation for their services, mostly in kind and some accept whatever monetary amount is given to them by the families (Humsein & Mpembeni, 2005). TBAs have a variety of names depending on where they are operating. They are all over the world, in developed or developing world, rural or urban. They are the Dias of India,dunkuns of Indonesia, the iji-ime of the Igbos, the agbesi of the yorubas and the abia unam of the Efiks.The traditional birth attendant also known as traditional midwife, community midwife or lay midwife is a pregnancy and childbirth care provider, World Health Organization(WHO, 2010).Traditional midwives provide basic healthcare, support and advice during and after pregnancy and childbirth, based primarily on experience and knowledge acquired informally through the tradition and practice of the community where they originate(WHO, 2010).
Traditional birth attendants could render services in their homes or churches as the case maybe; these practices have gained momentum by the day, as their services could be accessed widely. Frequently, their services include helping in household chores, massage of the women’s body, ante natal care, deliveries, care of the neonates and family Planning services. However, traditional birth attendants have no formal training on how to attend to pregnant women including how to recognize and respond appropriately to complications of pregnancy, for this reason, the way many attend to delivery was traumatic resulting in disability, leading to poor health outcomes and even death. (Rocker, Wilson, Mbaruka & Kruk, 2009). Traditional birth attendants are also described as members of the community, they share cultural and health beliefs with the women they serve and have strong ties with the community (Bultery, Fowler, Shaffer, Tih, Greenberg, Karita, & Cock 2010). Some women become Traditional birth attendants in the communities by working with and beside their mothers, other female’s relatives or other Traditional birth attendants (Syamala, 2007).Some women are selected as TBAs by the community based on some characteristics that members of the community perceive are required for assisting women with deliveries such as good deliveries outcome, a strong personality, stable emotional state, understanding of the culture, along with the patience that will enable the birthing woman to move through the event with courage, power and ease (Brugemann, Parpinelli, Osis, Ceratti, & Neto 2007; Smith, 2006).
During Pregnancy women seek help from TBAs who are readily available since they (TBAs) perceive pregnancy as a period of trials and crisis for the woman and her family, while also being in a spirit of anticipation to bare a precious gift (baby), the woman will always want an understanding and comfort- providing hand to care for her throughout the period of gestation. There is a growing awareness in many African Countries that TBAs have a major role to play in the prevention of HIV and maternal death through improved antenatal practices (Sibley, Sipe, Brown, Diallo, McNatt & Habarta, 2007). This is because of their accessibility to communities and the relationship they share with women in local communities especially if the women are unable to access biomedical skilled services (Maternal Health Task Force, 2011).
Wallace and Ebraham (2004) observed that many women patronize TBAs as against utilizing modern health services even when they (TBAs) work in a world of scientific ignorance with skills developed through trial and error, and being very deeply rooted in some harmful cultural practices of their countries which results in poor health outcomes. Therefore, improving the skills and knowledge of traditional birth attendants, providing sterile equipment and enlisting their assistance and support in disseminating information to the community are critical steps to improving their care of pregnant women at the community level (WHO, 2005).
Delivery by skilled professionals is an important factor in reducing maternal and infant mortalities. It is essential that each birth be attended to by trained personnel who give the necessary supervision and care during pregnancy, labour and the postpartum period (World Bank, 2005).The WHO (2004) refer “skilled attendants” as referring exclusively to people with midwifery skills i.e. doctors, midwives and nurses who have been trained to proficiency and licensed in the skills necessary to manage normal deliveries and diagnose, manage or refer complications. However, traditional birth attendants trained or untrained are excluded from the category of skilled birth attendants (World Bank, 2005) as they lack the knowledge of antenatal labour and postpartum care.
Statement of Problem
Despite all effort by government and agencies, to improve the knowledge and practice of Traditional Birth Attendants through training programs, provision of delivery kits and other equipment’s necessary for emergency obstetric care, maternal and newborn outcomes continue to be a major public health challenge in developing Countries. The reduction in maternal and infant mortality makes key indicators of two sustainable goals (SDG4&5) clearly unachievable. Each year more than half a million women die from causes related to pregnancy and childbirth, whilst nearly 4million newborns die within 28days after birth (WHO, 2010). Worldwide 34% of birth i.e.4.5 million births occur at home assisted by an unskilled (family member, traditional birth attendant) or nobody at all (WHO, 2012) this delivery by unskilled attendants is responsible in parts to the death of pregnant women and newborns. In the Southern part of Cross River State substantial amount is spent on health care, with the implementation of free medical treatment for pregnant women and children, women still go to the TBAs for care, more still .Series of trainings have been conducted for TBAs with provision of materials and equipment for emergency obstetric management to improve their knowledge and practice yet delivery outcome for mother and baby are still poor, with about 110 maternal death yearly (Cross River State MOH Maternal survey,2014) It is based on this premise that the researcher is undertaking this study on knowledge and practice of antenatal, labour and postpartum care among the TBAs.
Purpose of the study
The purpose of the study is to determine the knowledge and practice of ante natal care, labour and postpartum care among traditional birth attendants in Southern Cross River State. The study has the following specific objectives.
Specific objectives were to:
- Assess knowledge of antenatal, labour and postpartum care among the TBAs
- Determine the practice of antenatal, labour and postpartum care among the TBAs
- Ascertain the influence of socio-demographic variables on the knowledge of antenatal, labour and postpartum care among the TBAs
- Ascertain the influence of socio-demographic variables on the practice of antenatal, labour and postpartum care among the TBA
- Ascertain the influence of knowledge of antenatal, labour and postpartum care on the practice of antenatal, labour and postpartum care among the TBAs
H0: There is no significant relationship between the socio-demographic variables and the knowledge of antenatal, labour and postpartum care.
H0: There is no significant relationship. Between the socio-demographic variables and the practice of antenatal, labour and postpartum care.
H0: There is no significant relationship between knowledge and practice of antenatal, labour and postpartum care.
Significance of the study
TBAs have been a global concern to W.H.O, UNICEF and World Bank basically because of their contributions to newborn and maternal health outcomes. Series of trainings and workshop have been organized by different countries and organizations to improve their knowledge and practice of Antenatal, labour and postpartum care. However, despite the numerous trainings, newborn and maternal outcomes are still poor. The findings from this study will therefore give a better understanding of how maternal and fetal outcomes can be improved. The findings from this study will also contribute significantly to the growing body of scientific knowledge on best practices for ante natal, labour and post natal care.
Scope of the study/delimitation
The study was delimited to TBAs who care for pregnancy women in Akamkpa, Biase, Calabar Municipality and Calabar South Local Government Areas of Cross-Rives State. The study was confined to the following variables, knowledge of antenatal, labour and postpartum care, practice of ante natal, labour and postpartum care and factors that influence the knowledge and practice of antenatal, labour and postpartum care.
Operational definition of terms
Traditional birth attendants (TBAs): Are women, who care for pregnant women, assisting the women at child birth and who initially acquired their skills through apprenticeship delivering babies on their own or with other TBAs. They live in the Southern part of Cross River State, and are part of the culture and tradition of the people of the Southern part of Cross River. Have a high social standing as well as exerting influence on local health practices usually self-taught or informally trained, they also provide advice and practical help. They generally hold a position of respect and influence within their families, and in the Southern part of the State.
Pregnancy: Is the period during which a woman carries a developing fetus normally in the uterus. Pregnancy last for approximately 280 days from the first day of the last menstrual period.
Labour: Is the process whereby a viable fetus, placenta and membranes are expelled from the uterus, into the pelvis or birth canal and through the vaginal orifice. Normal labour culminates in the birth of a baby in the Southern part of Cross River State.
Post-partum: Is the period from delivery to six (6) weeks after giving birth. The post-partum period or puerperium, starts about an hour after the delivery of the placenta, and includes the six weeks after the mother gives birth in the Southern part of Cross River State.
TBA Knowledge of antenatal care-All that the TBAs knows about care of a woman who is pregnant from the first visit of the woman to the home of the TBA till when the woman falls into labour example, weighing, urine testing, palpation, auscultation, vaginal examination.
TBA Knowledge of intra partum care: What the TBA knows about care of a woman from onset of severe lower abdominal pains with presence of mixture of mucus and blood from the vagina to when the woman begins to bear down. Example: carrying out vaginal examination, auscultation, to resuscitation of the newborn.
TBA Knowledge of post- partum care-All the things that the TBA knows about taking care of a woman from the time she deliver her baby till six weeks after e.g. Del of placenta.
TBA Practice of Antenatal care-The various activities carried out by the TBAs during the care of pregnant women in their homes. These care include-palpation, weighing, health talk etcetera
TBA Practice of intra partum care-This include the entire process of delivery of the baby. The various maneuvers and the clamping and cutting of the umbilical cord, resuscitation of the newborn, delivery of the placenta, and control of hemorrhage by the TBA.
TBA Practice of postpartum care-This is all the care given to a woman who has just put to bed in the home of a TBA, from the first day to six weeks after delivery, including subsequent care of the newborn and, post-partum advice.