Традиционные повитухи: роль и особенности оказания помощи при родах.

Person who provides maternity care informally

A traditional birth attendant (TBA), also known as a traditional midwife, community midwife or lay midwife, is a pregnancy and childbirth care provider. Traditional birth attendants provide the majority of primary maternity care in many developing countries, and may function within specific communities in developed countries. Traditional midwives provide basic health care, support and advice during and after pregnancy and childbirth, based primarily on experience and knowledge acquired informally through the traditions and practices of the communities where they originated. They usually work in rural, remote and other medically underserved areas. TBAs may not receive formal education and training in health care provision, and there are no specific professional requisites such as certification or licensure. A traditional birth attendant may have been formally educated and has chosen not to register. They often learn their trade through apprenticeship or are self taught; in many communities one of the criteria for being accepted as a TBA by clients is experience as a mother. Many traditional midwives are also herbalists, or other traditional healers. They may or may not be integrated in the formal health care system. They sometimes serve as a bridge between the community and the formal health system, and may accompany women to health facilities for delivery.

Traditional birth attendants are often older women, respected in their communities. They consider themselves as private health care practitioners who respond to requests for service. The focus of their work is to assist women during delivery and immediately post partum. Frequently their assistance includes helping with household chores. TBAs may not have any formal training on how to attend pregnant women. Many are highly experienced in well woman care including how to recognize and respond appropriately to complications of pregnancy. It is a matter of discussion whether the lack of education in some TBAs and the way many attend deliveries are risky for the mothers and their babies. Evaluating the impact of these traditional practitioners on health outcomes requires taking into consideration additional factors such as poverty, availability of health services, or institutional support. It is being increasingly recognized that TBAs may have a role to play in improving health outcomes in developing countries because of their access to communities and the relationships they share with women in local communities, especially if women are unable to access skilled care. Some countries, training institutes and non governmental agencies are initiating efforts to train TBAs in basic and emergency obstetric care, family planning, and other maternal health topics, in order to enhance the links between modern health care services and the community, and to improve the chances for better health outcomes among mothers and babies. There is little evidence of large scale effectiveness of targeted intervention programmes for training TBAs, as they are rarely integrated within a general strategy for improving maternal and child care. TBA training has been used as a means of extending health services to underserved communities in developing nations in hopes of decreasing mortality and morbidity. As a result, there has been a shift toward skilled birth attendants, capable of averting and managing complications. The TBA role in the community should not be overlooked; they are highly respected members and proven assets in addressing poor maternal outcomes. TBAs have been unsuccessful in handling obstetric complications, The key piece missing in TBA training is an adequate referral system, which allows TBAs to use their close ties with the community to link pregnant women to skilled birth attendants (SBA). The effectiveness of TBA referrals to health facilities is dependent on the healthcare system’s ability to support an increase in services provided and the supervision needed to support TBA integration. Training that advocates collaboration and regular involvement in clinic duties, increases the number of referrals and improves communication.

“Most maternal deaths from direct causes (such as hemorrhage, obstructed labor, infections, eclampsia, or unsafe abortions) could be prevented if women received timely care at critical moments.” On average, half of deliveries in the developing world have a skilled birth attendant present. access to transportation and communication are critical to improve maternal and infant outcomes. Major contributing factors to maternal death are: “delay in recognizing danger signs, deciding to seek care, reaching care, and receiving care at health facilities”.

Uganda: UNFPA provides TBAs with solar powered VHF radio that connects directly to the health provider, walkie talkies for TBAs, and ambulance services. UNFPA has reported success. UNFPA stresses the importance of both communication and transportation to improve service delivery of maternal health services. and community or individual prepayment schemes ).”
“Birth emergency plans (also known as birth preparedness/complication readiness plans).”

In developed countries, some traditional or lay midwives are becoming increasingly vocal in support of their right to practice without formal regulation, advocating for a woman's right to choose her place of birth and birth attendants. They see their role to include promoting change in societal attitudes towards birth, and favouring the "art" of midwifery founded on maternal or compassionate instincts, rather than over medicalization of this natural event.