Traditional birth attendant

A traditional birth attendant (TBA), also known as a traditional midwife (TMs), is a primary pregnancy and childbirth care provider. Traditional birth attendants provide the majority of primary maternity care in developing countries, and may function within specific communities in developed countries. Traditional midwives usually learn their trade through apprenticeship, although some may be wholly self-taught. They are not certified or licensed.

Traditional midwives often provide health advice and education, and health care beyond the field of maternity. In much of the world, one of the criteria for taking the office of midwife is experience as a mother. Many traditional midwives are older mothers; many are post-menopausal. Many midwives are also herbalists, or other traditional healers. They may or may not be integrated in the formal health care system. They often serve as a bridge between the community and the formal health system, sometimes accompanying women to health facilities. The focus of their work is usually assisting women during childbirth delivery and in the immediate post-partum period. Frequently their assistance also included helping with household chores. Most traditional midwives travel to the pregnant woman’s house to provide care; women may also travel to them to obtain care. Traditional midwives are usually assisted by the birthing woman's relatives.

Many traditional midwives live in rural, and often isolated communities. They may work at considerable distance from health facilities.

There has been considerable effort placed on the education of traditional midwives, TBAs, in the last thirty years with little success. Most training programmes have focused on training the traditional midwives with little attention paid to the environment in which they work. Other issues must be addressed for traditional midwives to be able to provide optimal care including integration of traditional healers into the formal health care system, conditions for referral, access to equipment, adequate transportation, and other related issues.

Developed Countries
In developed countries, traditional, lay midwives may sense increasing pressure to submit to regulation of their practice. Many may resolutely resist any type of certification or license, being content with their lay status and enjoying the simple, domestic nature of their vocation. Some may have conscientious objections to outside interference, believing that regulation may place them as well as the families they serve in a compromised position regarding the physical, emotional, mental and spiritual well being of mother, child and the family unit. A common view is that midwifery is an ancient art that belongs to the community of women. Some direct entry midwives believe they are called to this work and look to their creator and those they serve for approval rather than outside organizations who have proven themselves historically to be hostile to the midwife as well as the families who seek her service.

For this and other reasons TBAs may be suspect and disdainfully rejectful of the attempts by any organization to define, professionalize or regulate their practice.

Traditional, lay midwives are likely to belong to certain subcultures or religious groups. Of the midwives who are religious practitioners, a focus of their practice may well be to exclusively attend the births of women of like faith.

Professional midwifery care is cost prohibitive for many families, particularly for those with convictions regarding government assistance. Christians, for example may be inclined to refuse state or federal welfare. Conscientious objections to dependence on secular government for familial needs and a preference to trust Jesus to provide may keep Christians from looking outside of their innermost circle for midwifery care.

Furthermore, certain families highly regard their privacy and view birth as such an intimate process that they may be hurt or humiliated in being billed by a midwife for the privilege of attending the birth of their child -thus the growing movement of unassisted childbirth. Among these families there is a need for the services of Traditional Birth Attendants who are willing and able to serve without demand for compensation. One way this may be accomplished is for believers in any given local to provide a continuum of practical support, such as living arrangements, etc. to their community midwives.

Last, there is the issue of emergency childbirth. Natural and man made disasters from hurricanes or epidemics to terrorist attacks(real or synthetic) in highly populated cities have the potential of causing a demand for birth attendants that would overwhelm the medical establishment. In times like these, there would be no replacing the Traditional Birth Attendant. There is neither a replacement for a common knowledge of natural, home birth and women helping women in their local communities, which is where the TBA has its organic roots.