Traditional birth attendant

TBAs may not receive formal education and training in health care provision, and there are no specific professional requisites such as certification or licensure.

[2] 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.

[4][8][9] 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.

[10] 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.

[12] TBAs have been unsuccessful in handling obstetric complications,[12] but have contributed to successful maternal, neonatal, and child health interventions, although there is insufficient evidence that TBA training improves peri-neonatal mortality.

[13][14][15][16][17][18][19][20][21] 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).

[12] The World Health Organization’s Strategies and Interventions for Obstetric Referrals: “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.” [26] On average, half of deliveries in the developing world have a skilled birth attendant present.

[28] Malawi: Communities have employed bicycle ambulances and oxcarts to transport pregnant women to health facilities.

[34] Nigeria: Community leaders negotiated a contract with a local bus union to transport women with obstetric emergencies.

In the event of a death police and local authorities were made aware of the arrangement, so that bus drivers would not be held liable.

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.