Abstract
Purpose
To examine traditional birth attendants (TBAs) and their care in the Republic of Madagascar through an analysis of care and perceptions from TBAs and women who receive their care.
Method
The researcher spent two months in the village of A on the outskirts of the city of Antsirabe in the Republic of Madagascar. Four TBAs and 11 women who received TBA care currently and in the past participated in semi-structured interviews. Interviews covered care and perceptions of TBAs and the evaluations of women receiving their care. In addition, a TBA accompanied the researcher while observations at a TBA care site were conducted. Data were qualitatively analyzed, sorted, and discussed.
Results
TBA activities included physical examinations during pregnancy, care during delivery, and home visits following birth. Fundamental objectives at the core of TBA care were to check the position of the child, promote labor progression, and regulate body temperature of the mother. Women who received care reported that TBAs relieved fatigue, served as a source of childbirth knowledge, and provided strength during delivery. In contrast, the women felt that TBAs did very little following the birth. Perspectives on TBA care from the women who received care agreed with that of TBAs themselves close to 50% of the time. Differences in perspectives may have arisen from the fact that the women did not remember the care they received during delivery, and because the guidance was provided based on experience and traditions and thus lacked detailed substance.
Conclusion
Results showed that TBAs need to supplement their knowledge in addition to fulfilling their valued role as doulas in order to meet women's needs. To this end, effective training practices are needed in conjunction with initiative to overcome barriers such as tribal status and pride as medical workers. Performance of practical actions to enhance their understanding of TBA care will enable them to fulfill their valuable support role more effectively.
