Perceptions and practices of traditional birth attendants in a tribal area of Maharashtra: A qualitative study

Background: Even with enhanced efforts to increase institutional births in India, an alarming number of deliveries are still being carried out at homes. Most of these home deliveries are carried out by traditional birth attendants (TBAs). In such situations, practices and perceptions of the TBAs are utmost important to identify possible harmful practices. Objective: To explore the perceptions and practices of traditional birth attendants in tribal area regarding care during pregnancy and childbirth. Methodology: Qualitative research, in depth interviews were conducted with traditional birth attendants at their houses during June to August 2010 in Sakwar, tribal part of Thane district, Maharashtra. TBAs who had conducted at least one delivery in last one year were included in the study. The data was analysed manually using thematic analysis framework. Results: All the participants were women above 45 years belonging to warli community. Antenatal care registration was rarely advised due to lack of contact with the expectant mothers before nine months. Identifying danger signs during pregnancy and intrapartum period was uncertain among the TBAs. Almost all TBAs had clean delivery practices except lack of knowledge of timing for hand wash. TBAs had no knowledge about need for arrangement for transport and importance of prompt referral. Intrapartum danger signs known to TBAs were hemorrhage and prolonged labor. The duration of prolonged labor and quantity of blood loss was not standardized among the TBAs. Bathing the newborn immediately after birth followed by initiation of breast feeding was a common practice. Conclusion: The practices and perceptions of TBAs in identifying antenatal and intrapartum danger signs remain uncertain. Practices such clean delivery practices, early initiation of breast feeding need to be further strengthened with emphasis on education, information, behaviour change about clean hands and exclusive breast feeding.