Training in the management of Obstetric emergencies is essential to prevent unnecessary disability and death in women. It is very important that all training is tailored and targeted for the group of healthcare workers being trained. All skilled birth attendants in the UK received skills updates every year.
In Pakistan, this is often not the case. There are three main groups of maternity healthcare providers. Firstly the trained doctors who are not working in hospital settings and do not take part in mandatory Clinical professional development programmes. These doctors remain on front line duties facing Obstetric emergencies all the time but unfortunately do not initiate or are part of programmes where they have to keep their knowledge up to date. Some NGO’s are involved with this cadre to improve and update skills with an aim to reduce maternal mortality and morbidity.
The second group are the trained nurses or midwives who provide midwifery care to women. These health care professionals usually work in district general hospital or smaller hospitals where they do not have the support of trained doctors’ majority of time. They have their experience and knowledge of working in obstetrics for many years but unfortunately have no formal training programmes to either update their skills or to learn new skills which would help them improve their care for the women they deliver. Some NGO’s are also involved with improving skills of this cadre.
The third group is that of the traditional birth attendants. This group is largely controversial and due to their lack of regulated training is blamed by the above mentioned group for the majority of the complicated cases that arrive too late in the hospitals, and present in a moribund state. The reality is that the services offered by TBAs are the most commonly used healthcare provider used by women, particularly in rural areas. This is due to many reasons, such as social (many women are not permitted to attend hospital to give birth for fear of exposure), financial (expensive, unaffordable healthcare, financial bribes by staff, or costly transportation to hospital) and a lack of any other service available (an absence of healthcare staff at the facility, as there is a global shortage of nurses, midwives and doctors).
Published research (Wilson et al, 2011, BMJ) suggests that engaging more with this group, by training and supporting them to detect and refer women experiencing signs of obstetric complications can improve outcomes for women and their babies.
Until societies decide that saving women is an absolute priority (economically and socially) and increase the numbers of skilled birth attendants to allow every pregnant woman to have a skilled birth attendant, like here in the UK. We should look to TBAs to fill the gaps. Evidence has shown that they can be effective, we should not ignore this. If there are interventions that work then we should use them. We cannot not ignore evidence; we should support TBAs until we have the optimal intervention to reduce maternal death – a skilled birth attendant such as a midwife or a doctor.