Traditional birth attendants in rural Nepal: Knowledge, attitudes and practices about maternal and newborn health

Abstract

Efforts to formalise the role of traditional birth attendants (TBAs) in maternal and neonatal health programmes have had limited success. TBAs’ continued attendance at home deliveries suggests the potential to influence maternal and neonatal outcomes. The objective of this qualitative study was to identify and understand the knowledge, attitudes and practices of TBAs in rural Nepal. Twenty-one trained and untrained TBAs participated in focus groups and in-depth interviews about antenatal care, delivery practices, maternal complications and newborn care. Antenatal care included advice about nutrition and tetanus toxoid (TT) immunisation, but did not include planning ahead for transport in cases of complications. Clean delivery practices were observed by most TBAs, though hand-washing practices differed by training status. There was no standard practice to identify maternal complications, such as excessive bleeding, prolonged labour, or retained placenta, and most referred outside in the event of such complications. Newborn care practices included breastfeeding with supplemental feeds, thermal care after bathing, and mustard seed oil massage. TBAs reported high job satisfaction and desire to improve their skills. Despite uncertainty regarding the role of TBAs to manage maternal complications, TBAs may be strategically placed to make potential contributions to newborn survival.

Keywords:

• traditional birth attendants
• knowledge attitudes practices
• newborn care practices

Acknowledgements

Funding support from: NICHD Grants HD 44004 and HD 38753, USAID cooperative agreements HRN-A-00-97-00015-00 and GHS-A-00-03-000019-00, and the Bill and Melinda Gates Foundation (810-2054). Our gratitude is extended to the staff at the Nepal Nutrition Intervention Project, Sarlahi (NNIPS), with special thanks to Mr. Shishir Shrestha, Mrs. Solochana Chaudhary, and the local TBAs who shared their experiences with us.

Notes

1. Maithili is the dialect spoken by the Madeshi ethnic group residing in southern Nepal and northern India.

2. ‘Massaging the placenta’ refers to pressing gently on the placenta.

3. ‘Milking the umbilical cord’ refers to gently pushing/pulling on the cord. The belief is that manually ‘pushing’ the blood within the cord towards the baby will exaggerate or maximise the transfer of blood to the baby from the umbilical cord and ‘send breath towards the baby’.