One of my concerns as we began this process was that the WHO has recently changed focus from the training of Traditional Birth Attendants (TBAs) stating that training for TBAs takes away from efforts that will make a real difference in maternal health. On the whole I like the WHO, but I couldn’t agree with this statement–at least not as a global truth.
I was very glad to find a study in the New England Journal of Medicine from 2005 that showed teaching traditional birth attendants was making a difference in women’s health in Pakistan. The tools and training available to these TBAs? The birth kit they were given for each woman had sterile gloves, soap, gauze, cotton balls, antiseptic solution, and umbilical cord clamp and a sterile blade. With just being given access to clean equipment the perinatal death rate went from 1.2% to .8%. I sincerely hope more studies like this come out and that WHO changes its mind about the skills of traditional birth attendants.
We have been using the language of the WHO, and calling the women we will train Skilled Birth Attendants. We are even using their list of required skills as our teaching outline. But this is where it gets goofy. Some of the things on their list are simply not available to the women we will be teaching. For example, they are supposed to be able to do active management of third stage labor — essentially using synthetic oxytocin to stimulate contractions to have the placenta be born. Or to test for different STDs. Most of Central Africa won’t have access to medications, laboratories or other tools needed to accomplish these things in the “modern” way –unless some organization wants to be funding them.
I agree the governments should continue to build a health infrastructure. But I cannot agree that we must wait until these are in place to begin training birth attendants.