Traditional Birth Attendants' role to change

By Rachel Horner and Kevin Hill

The Minister of Health has called for a reorganization of the way women in Sierra Leone give birth and will focus on the role of the traditional birth attendant. Currently one in eight women is at risk of dying while giving birth in this country.

“People who are in attendance aren’t able to deal with complications. Often these people are traditional birth attendants. They are not trained in any scientific way. We are going to change their role”, said Health Minister Soccoh Kabia.

According to the minister, the traditional birth attendants will be responsible for identifying pregnancies in their communities, referrals to health care providers and making sure women show up for appointments. They will also focus on antenatal and perinatal care, immunizations and dispensing vitamins, leaving deliveries to trained medical practitioners.

“We will get to the point of discouraging home deliveries. It will take time, 2 or 3 years, we must be systematic about it.”

The UN Children's Fund (UNICEF) estimates that almost half of all births in developing countries occur without a skilled birth attendant present - in Sierra Leone that number drops to only 43%. Globally, 529,000 women die every year in pregnancy or birth, according to the World Health Organisation (WHO).

Minister of Health, Dr. Soccoh Kabbia, said that as part of the APC government’s health strategy the government is trying to answer the question, “why do women die?”

10-15% of all births have serious complications, including anemia, obstructed labour and infectious diseases not addressed prior to delivery. Delay in getting these complicated cases to a qualified medical practitioner causes numerous preventable deaths.

According to Dr. Thorlie, head of Princess Christian Maternity Hospital, women are at risk when using the services of traditional birth attendants because they cannot handle post-partum hemorrhaging or any other unpredictable complications that might arise during delivery.

“Traditional birth attendants are there to do normal deliveries. They are trained by an NGO then they go practice. They used to train old women with a lot of experience dealing with births. These days they train people who have no experience.”

TBAs can also administer oxytocin drugs, which are used to encourage contractions of the uterus to facilitate delivery. Used incorrectly these drugs have the potential to do great harm.

“TBAs give the drugs anytime, given too early causes hemorrhaging”, said Dr. Thorlie.

“We need to reorganize our health system.”

Amie Kondeh is a traditional birth attendant has been in the job for over 30 years. Kondeh is very popular in the Ginger Hall community for expectant mothers said she has never had a complication during delivery and no woman has died on her watch.

However, she said that “now (recently trained) TBAs have no patience in doing delivery, they care only for the money rather than the safety of the pregnant women and the unborn baby”, she said.

“I learned this job when I was in the bondo society bush in the early ‘60s. We were trained by the head of the Bondo society to delivery pregnant women. I believe it is a gift.”

Kondeh is not educated and cannot even speak Krio, but she is confident of her ability to deliver babies, even more than trained nurses.

Women normally pay Ms. Kondeh Le50,000 or Le60,000 for delivery - a big savings over the cost of a hospital stay.

During the interview with Concord Times, a pregnant woman approached Ms. Kondeh to deliver her child. While in great pain Marie Kamara told me that Kondeh had delivered 3 of her children and that she is sure of her delivery methods.

Kondeh’s delivery room is small with a little window. It has neither proper ventilation nor light. As Marie prepared to give birth, the room was very warm. Kondeh, the pregnant women and some other women attending were sweating profusely in and out of the room.

Marie successfully delivered a baby girl. Both are healthy despite the lack of trained medical practitioners and the risk involved.

For Sister Mansary, nurse at PCMH, getting to a hospital in a timely fashion is essential for safe deliveries. “You need expert attention. Most people have difficulty in transportation, causing delays. By the time they get into the major centres it is too late. This contributes to the high rates of maternal mortality.”

The delay in getting to hospital can be exacerbated by the actions of the traditional birth attendants. “Traditional Birth Attendants are not even trained. When they finish mismanaging (deliveries) they bring them here,” said Ms. Mansaray.

PCMH handles up to 8 or 9 caesarean sections per day. Most of the patients survive, but it depends on their condition upon arrival.When pregnant women arrive at the hospital long after complications to the pregnancy have been identified, the woman and child’s chances of survival are greatly diminished.

“When they want to deliver they go to traditional birth attendants, (but) they refer these complicated cases too late”, nurse Mansaray said.

According to Sister Taylor-Young, a nurse anesthetist, the lack of qualified and trained people means that pregnant women often trust those who cannot help in the case of a complicated delivery. “Everyone is a midwife, everyone is a doctor. Finally everyone fails. Abnormalities found early (means) lives will be saved.”

Sierra Leone’s devastated health care system cannot currently manage all the births that occur in the country. If the additional case load that is now managed by traditional birth attendants hits the hospitals the system will fail unless massive donor assistance can be found.