Asian Cultural Practices Regargding Pregnancy, Childbirth, Placentas, and Family Roles
- Research article
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Initiation of traditional birth attendants and their traditional and spiritual practices during pregnancy and childbirth in Republic of ghana
BMC Pregnancy and Childbirth volume eighteen, Article number:64 (2018) Cite this article
Abstruse
Background
Prior to the appearance of modernistic obstetric services, traditional birth attendants (TBAs) have rendered services to pregnant women and women in labour for a long time. Although it is anticipated that women in contemporary societies will requite birth in hospitals and clinics, some women notwithstanding patronize the services of TBAs. The study therefore sought to gain an in-depth understanding of the initiation of TBAs and their traditional and spiritual practices employed during pregnancy and childbirth in Ghana.
Methods
The pattern was an exploratory qualitative i using in-depth private interviews. Data saturation was reached with 16 participants who were all of Christian religion. Interviews were conducted with a semi-structured interview guide, audiotaped and transcribed verbatim. Content analysis was employed to generate findings.
Results
The findings showed that TBAs were initiated through apprenticeship from family members who were TBAs and other non-family unit TBAs likewise as through dreams and revelations. They practice using both spiritual and concrete methods and their work was founded on spiritual directions, apply of spiritual artefacts, herbs and physical examination. TBAs delay cutting of the cord and disposal of the placenta was associated with behavior which indicated that when not properly disposed, information technology volition accept negative consequences on the child during machismo.
Conclusion
Although, TBAs like maternal wellness professionals operate to improve maternal wellness care, some of their spiritual practices and behavior may pose threats to their clients. Nevertheless, with appropriate initiation and training, they can get useful.
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Background
Despite efforts to reduce maternal and babe mortality, depression and middle income countries go along to report significant mortality rates, with some of the reasons being poor access to or low quality of professional person intendance [i, ii]. In Africa, traditional birth attendants (TBAs) have historically been the major caregivers for women during childbirth [3, 4]. Like many low and heart-income countries, pregnant women in Ghana go along to either give birth at home or with TBAs [v]. A Traditional nascency attendant (TBA), according to WHO is "a person who assists a mother during childbirth and who initially caused her skills by delivering babies herself or through apprenticeship to other traditional birth attendants" [6].
In Ghana, traditional midwifery has been a part-time work for unskilled persons who mediate pregnancy and birth with some spiritual practices. Many TBAs rely on herbal medicines which are culturally inherited to assist women before, during and after labour [7]. Meanwhile, research suggests that these TBAs have had very little grooming and education that might integrate them into the larger health care system and fifty-fifty those with training need the support of skilled back up services [8, ix].
In 1987, introduction and adoption of safety motherhood programmes in Republic of ghana drew attention to the demand for women to patronize professional healthcare services during pregnancy and childbirth [10, eleven]. Yet, these services are express and not easily accessible or of depression quality. In rural communities, over 30% of meaning women do not take access to skilled nascency attendants. Therefore, some of these women proceed to access the services of TBAs. According to the Ghana Maternal Health Survey of 2014, 16% of deliveries were supervised past TBAs [12]. However, in that location is a dearth of information on the type of back up and remedies they provide to women during pregnancy [13].
TBA care has been known to cut across pregnancy, labour, postpartum and care of the newborn [fourteen]. Preference for TBAs has besides been attributed to the fact that they provide affordable [fifteen] and accessible services as well as bear delivery at home- an environment familiar to the woman [16, 17]. Agreement and respect for the religious behavior of clients is too associated with the preference for TBAs [18]. Furthermore, in a country like Ghana where wellness services are inadequate, the services of TBAs continue to be in demand [19, 20]. It is thus, observed that health policies that neglect the impact of TBAs would non be constructive considering some women however adopt home commitment and TBA services [5, 17]. Hence, an in-depth understanding of the initiation, traditional and spiritual practices of TBAs is relevant for policy making.
Previous authors report that initiation into TBA practice includes formal training by district wellness staff and organizations [21], sacred calling through dreams or visions [22] and inheriting or apprenticeship from close relatives such equally mothers [3]. The apprenticeship has the duration of ii to five years under a family member but ane to two years when the trainer of the TBA is not a family member [23] probably considering of commitment and paid grooming for those who are not family members. The findings also pre-suppose that TBAs acquire on the job and hence may not benefit from scientific and standard processes of childbirth. The literature reports that TBAs keep the pregnancy condition of a woman secret until signs of pregnancy are obvious in society to protect both mother and infant [24]. They too assess the vagina for cervical dilatation during labour and some mind to fetal heartbeats by positioning a bamboo on the abdomen [25]. Some TBAs place women in labour in a pounding mortar and when labour unduly delays, the woman is accused of concealing secrets such as infidelity and that labour will only progress after confession [25, 26]. Traditional birth attendants also utilize herbal medicine [27] to manage prolonged labour and retained placenta [28] but when overwhelmed past complications they refer to wellness facilities [29].
Some TBAs add spiritual practices to their care [19] with the belief that meaning women are susceptible to spiritual attacks that can hinder successful outcome [thirty]. In view of this, before childbirth TBAs offer prayers [28] for effortless and safe birth [31]. Some believe that a jerk of a right arm or eye is an indication of simple labour but complications are anticipated if the left was involved [22]. For most cultures, placenta and other birth products are associated with rituals [32]. For instance, in some cultures people believe that the placenta is buried, burnt or thrown into a river just later on childbirth because contact with vaginal blood could cause ill-health or premature death [33]. Notwithstanding, at that place is fear that when the placenta is disposed of inappropriately, evil people can employ information technology to harm the baby [34].
Although, the literature presented some knowledge on the initiation and practices of TBAs from various contexts including Ghana, the authors of this report observed a need for further insight equally most of the studies have inadequately explored the topic. It is noted that near authors emphasized the need for the preparation of TBAs to promote maternal and neonatal wellbeing [35, 36]. Improved care could reduce maternal and neonatal deaths [xix]. The authors of this study conceptualize that understanding the practices of TBAs will inform future training programmes that could enhance maternal intendance and wellbeing. Hence, this qualitative study was designed to explore the initiation of TBAs and the spiritual practices they use during pregnancy and childbirth in Ghana.
Methods
Design
The study adopted an exploratory qualitative blueprint to gain in-depth understanding of the initiation and practices of TBAs as well every bit spiritual influences of their initiation and practice. The qualitative design allows probing and further exploration of emerging findings and was deemed appropriate for the written report [37, 38]. This design was useful because we did not use an existing theory or framework but rather we used probes to follow-up on participants' responses. This process afforded a deeper understanding of emerging themes.
Setting
The study was conducted in a rural community in the Greater Accra Region (Kasseh) with the participants drawn from an organized grouping in Kasseh which includes TBAs. The Greater Accra Region is the smallest region in Republic of ghana and is fabricated upwardly of 16 authoritative areas. It is bordered on the north past the Eastern Region, on the east by Lake Volta, on the southward by the Gulf of Republic of guinea, and on the due west by the Central Region. Co-ordinate to institutional data, maternal mortality ratio has worsened in the Greater Accra Region since 1992 as compared to the other authoritative regions in the country [39]. It is thus imperative to sympathize the basis for the unexpected outcome by examining quality of care provided to women in this region which includes TBAs services.
Kasseh is a major boondocks located between Sege and Sogakope on the Accra-Aflao road. Kasseh has the biggest market in four districts (Ada Westward, Ada Eastward, Southward Tongu and N Tongu) in its area. Information technology is continued by road to the district capital, Ada-Foah and a town called Big Ada. Although it is the most hands accessible town in the district, poverty is widespread. Majority of the ethnic people are subsistence farmers using non-mechanized rain fed agriculture and the minority existence fishermen and traders. They are also highly religious with the majority of the population being Christians.
This setting was chosen considering its communities were mainly emerging developments with express admission to health facilities that provide pregnancy and delivery intendance. Information technology was also deemed as the appropriate place to become the targeted participants equally there is also an organized group of TBAs in the boondocks. The grouping includes TBAs from rural communities within the district who were believed to have adequate feel in traditional practices during childbirth. It is called "Association of TBAs, Herbalists and Spiritual Healers". The association was established with 83 members but currently has a membership of 42. That is, 16 males and 26 females. The group at the time of data collection was fabricated up of Christian TBAs. The grouping was formed every bit a means of bringing together all TBAs, Herbalists and Spiritual Healers in the community to network and share ideas. Members of the association come across every third Monday of the calendar month to discuss progress, shortfalls and other relevant bug pertaining to their practices.
Sampling and data collection procedure
Using a purposive sampling technique, both males and females were recruited. To be included in the study, TBAs should have practiced for two years. Permission was obtained from the leaders of the associations to enable the researcher book appointments according to the meeting days of the groups. A trained inquiry assistant who could speak the Ada language fluently assisted the starting time author every bit a translator during the interviews of participants who simply spoke Ada language. The interviewer (first author) does not speak the Ada linguistic communication fluently. Other interviews were conducted in Twi and Ga. But ane participant spoke English language during the interview. The interviews lasted between xxx and 45 min. The interviews started with a general question such every bit: 'Please tell me how you lot became a TBA' and responses were probed. Follow-up questions such as: 'Please tell me what you do for pregnant women when they come up to you'. In-depth understanding was achieved in this written report and concurrent assay helped in full exploration of emerging themes. Privacy was ensured during interviews and permission was obtained to record the interviews. The interviews were conducted in an enclosed place almost the coming together grounds. Participation in the study was also voluntary.
Data management and analysis
Interviews were transcribed in English language and an skillful in the local language who conducted the interviews checked the transcripts for accuracy. The research team read the transcripts several times to fully understand the perspectives of the participants. Concurrent analysis was undertaken using the techniques of content analysis. Inductive analysis processes were followed to develop themes and sub-themes since no theoretical framework informed the formulation of themes. The researchers independently coded the transcripts, grouped the codes and generated themes and sub-themes [forty]. The themes and sub-themes were discussed among team members to ensure the data were faithfully captured. The data were subsequently managed using the NVivo software version xi. Relevant data were sifted to support themes and sub-themes and the findings were presented with supporting verbatim quotes from participants.
Rigour
Rigour or trustworthiness of the study was achieved using a number of procedures. Emerging themes were farther investigated in subsequent interviews (member checking) until saturation was accomplished. The researchers undertook prolonged appointment with 16 participants and this ensured that the miracle nether investigation was fully understood. Also field notes were taken to record non-verbal observations and decision trails during the written report. Once more, independent coding and checking of transcripts ensured that the data and analysis were credible. Identification codes were used to nowadays verbatim quotes. The ID numbers were assigned chronologically as participants were recruited. For case TBA1M – TBA4M.
Ethical considerations
Ethical clearance for the study was obtained from the Institutional Review Board of the Noguchi Memorial Institute for Medical Research at the Academy of Ghana. Informed consent was obtained from all participants and the data was anonymized. Participants consented to the use of data for pedagogy and publication. Participants were also made enlightened of their correct to withdraw from the study at any given time.
Results
Demographic characteristics of participants
A full number of xvi TBAs participated in the report, four males and twelve females. Few males are engaged in midwifery/TBA; therefore, the number of males in this study depicts what exists in the general Ghanaian context [41]. They were anile betwixt 31 and eighty years and had been TBAs between 3 and over 40 years. All participants were Christians as there were no members from another organized religion in the grouping. Out of the 16 participants, ten were married, five were widowed and ane was divorced. The number of children they had ranged from 2 to 11. Ethnic backgrounds were Ada (xi), Ashanti (2), Ga (1), Kwahu (i) and Bono (i). They conducted v deliveries per month on average. None of the study participants had any formal education similar to all members in the group at the time of data drove. Within the socio-cultural context, it is rare for educated individuals to be TBAs dissimilar what the literature has shown in Republic of zambia where the commune health office sometimes trains TBAs.
Initiation of traditional birth attendants
13 of the Traditional Nativity Attendants (TBA) acquired skills of managing pregnancy and labour through grooming from a family unit member and apprenticeship from experienced TBAs whereas the others had spiritual revelations.
My elderberry brother delivers women in the house and so when he is going to deliver somebody, he calls me to come up and observe. (TBA10F); …I was taught past my mum; and then equally she does it, I learn. (TBA16F)
A participant claimed she received the revelation to be a TBA from her belatedly mother later several encounters with her through dreams.
…my female parent worked as a TBA before she died. …One day I slept and dreamt that my mum and I were going to evangelize someone. These kinds of dreams continued for about 12 months. And then I asked a TBA and he told me that my mother wants the work she left for me to continue. (TBA9M)
Another participant who was a pastor supporting a TBA with prayers stated:
I used to pray for a TBA before she delivers women considering I am a pastor…in some instances when she is delivering, she would ask me to discover. ...One day she travelled so at that place was nobody effectually to help the women deliver so I took it up and I'grand still in it. (TBA11M)
One TBA who was a hunter first, compensated for the killing of pregnant animals by assisting pregnant women during childbirth.
I was a hunter... I was asleep 1 day when God revealed to me that I should not hunt for animals again just evangelize women. This is because at times I killed some meaning animals that I never knew were significant. (TBA3M)
Two participants believed they received the calling whilst in their sleep and after they were confronted with the reality of profitable women to give birth and continued to do and so since. One subsequently underwent some basic training and became a certified TBA.
I had ii dreams that women came to me and I delivered them; on the third occasion, information technology happened physically; and then I followed what I saw in the dreams and delivered them successfully. After that then we had some teaching so at present I am a TBA. (TBA5F)
I did not learn it anywhere; it came to me in a vision… (TBA4F)
Spiritual and physical practices of TBAs
TBAs in this study continued to have spiritual revelations to direct them to manage women during pregnancy and labour. The participants used artefacts and different herbs during their work.
Some claimed they had spiritual directions to guide their management of women through hearing voices. They were conspicuously shown how to get about the delivery.
When the person comes to me I await at the stomach and a spiritual vocalization directs me on what to practise; …when I pray for the person, the Holy Spirit tells me the fourth dimension the woman will give nascency. (TBA4F)
…the spirit directs me as to what particular herb to employ. (TBA5F)
Some TBAs owned prayer camps (religious institutions that act as alternative hospitals for a diverseness of ailments in Republic of ghana) where they prayed for expectant mothers and gave them physical and spiritual guidance concerning their pregnancies. Some did deliveries in their prayer centres while others did so in their houses or that of their clients.
…since I stay in the camp, I go some revelations about the pregnant women where evil spirits prevent the infant from turning in the womb... (TBA7F)
A TBA believed that prolonged labour was an indication that the infant was spiritually locked up in the womb.
When the nascency of the child delays, it could hateful that the womb is locked by a spirit; after prayers everything is cleared and the child would come out quickly. (TBA6F)
Some TBAs asserted that they had "visions" of significant women coming to requite nascency with them before they were physically brought.
I encounter the women in a vision ready to give birth. …so when someone is brought in, she will await exactly similar the one I saw in the vision. (TBA15F)
Virtually TBAs perceived that obstructed and prolonged labour was a sign of adultery or adultery which was considered a taboo or was a result of relationship issues with other people.
... I told her "you lot have been unfaithful to your husband?" and she spoke the truth past letting me know what she did …after the confession, we prayed and I used the "anointing oil" on her before she had safe delivery. (TBA3M)
Apart from the visions and revelations that some TBAs received, they as well offered prayers and performed certain rituals for a prophylactic delivery focusing on removing effects of evil spirits.
I pray for her that God should help her deliver peacefully….. (TBA12F)
…information technology is not all the fourth dimension that information technology is physical, sometimes as well it is spiritual. My wife's father had to exercise some rituals before she could evangelize. (TBA1M)
Thirteen out of the sixteen TBAs used a number of artefacts (substances or items that accept been prayed over or blessed) in their practices with the conventionalities that it lessened hurting or enhanced delivery. Artefacts such as: blessed water, malt, milk, mixture of soda water and milk, anointing oil, a preparation of soap, a preparation of boiled water and oil, fresh ground okro, Ada common salt and cassava leaves.
Some TBAs prayed over water and gave it to the pregnant women to beverage.
…you would be praying and if you are directed to pray over water for her to drink, you exercise that and the babe turns or positions well and the mother kneels and she delivers hands. (TBA10F)
As well, the Ada table salt was used to perform some rituals which were believed to raise piece of cake delivery.
…my dad just brings Ada salt; I don't know what he says but earlier he finishes his rituals, the woman just delivers. (TBA1M)
Three TBAs used anointing oil:
…we besides bless their forehead and the tummy with anointing oil then pray before the procedure of delivery. (TBA3M)
One TBA prayed over a bottle of malt for the women to drink subsequently commitment:
...when you give nascence and I find your condition is not stable; I would pray over a canteen of malt and ask you to potable it. (TBA11M)
Another TBA prayed over a tin of milk and asked women to drink it during delivery specially when labour is prolonged.
...in some instances, the infant delays in coming out; and so, I purchase one can of milk, pray over it and when she takes information technology, she is able to give birth. (TBA6F)
A TBA perceived labour pain to hateful the presence of a kernel-similar substance and until it burst, pain will persist. The TBAs gave the pregnant woman a mixture of soda water and milk to drink..
When they are in pain, I brand them purchase a drinkable chosen "soda h2o" and I pour milk into it. The pain means there is something like kernel that must flare-up. When she drinks the soda mixed with milk, it bursts that thing and the pain stops. (TBA4F)
A TBA prepared special soap that has been prayed over for the pregnant women for bathing to revert any challenges they faced.
...sometimes when women come up, I ready special soap and pray over it for them to apply to bath….. (TBA5F)
Other TBAs gave a mixture of boiled water and oil in order to revive a distressed babe and give them strength.
...In instances where the baby does non turn and dies, I make them buy sachet water which I boil and add oil to it for them to beverage; when they drink the infant gains strength and become revived. (TBA7F)
Employ of herbs/material objects
Some participants used herbs regularly in their practice. "I boil herbs with the sap and bark of copse. I would give it to you to drink" (TBA5F).
Some of the herbs and Turkey berries (beduru) were used by TBAs as claret tonics that they believed were effective.
…nosotros have our own claret tonic where we give specific leaves and beduru (Turkey Berry) some used to set up Ghanaian dishes. Later you give the person inside one-time the person gets the blood. (TBA1M)
There were times where under the directions of the spirit, TBAs prayed over cassava leaves and used information technology to heal ill pregnant women.
…if a woman comes to me sick and I don't accept whatever medicine to assistance, later praying the spirit tin tell me to plug cassava leaves and use it to bathroom the adult female I requite information technology to the person to bath with it or to drink. (TBA1M)
Some TBAs said a slippery vaginal discharge was nowadays during labour. Thus, they gave significant women fresh ground okro (Abelmoschusesculentus) which they accept prayed over for the women to drink in order to excrete more than of these discharges.
...sometimes what we practice is that, we grind fresh okro, pray over it and give to them to drink. If you lot are going to give birth something slimy comes out like okro from under the adult female. After we have given you the okro, the baby turns…sometimes we milkshake the stomach and later on v minutes the child volition plough……. (TBA1M)
Other TBAs used some herbs to prepare a solution for enema to enhance the delivery of the baby.
...at that place is a herbal training for enema…if you know that the fourth dimension is due but the baby is delaying…you lot give the woman enema and afterward about 5 minutes the baby will come out. (TBA1M)
In addition, some TBAs attributed inactiveness of babies in the uterus to increased amniotic fluid. In the quest to remove the extra water, the TBAs gave pregnant women some herbal preparations believed to be diuretics.
…if at that place is more water effectually the kid, the child is not agile. Then I can give the woman a herbal drug which makes her urinate more and the kid is able to plough. (TBA13)
Some TBAs said their herbal preparations cannot be given in conjunction with the prescribed drugs from the infirmary.
…mine, when you beverage it now you lot wait for about two or three hours before taking that of the infirmary's.(TBA16F); ...when you go for the infirmary drug and bring it, nosotros will allow y'all to take all of it before you take my herbal medicine. I don't allow them to mix and then I can run across the effect well. (TBA13)
In cases of difficult or prolonged commitment, they inquire the women to chew and swallow sure leaves with salt.
…in some cases, the womb tightens and information technology becomes hard for the child to come out. We will pluck a leaf, and wash it, then put a small salt on it then we give it to her to chew and swallow and immediately, the child comes out. (TBA14F)
Physical examination and practices during pregnancy and labour
The TBAs confirmed pregnancy by vaginal examination to feel for a lump. During hard labour, the participants washed the abdomen with h2o and physically realigned the babe with breech presentation.
When they come I put my hand inside to feel a lump in that location indicating that they are meaning. Afterwards that the pregnancy grows; when they feel labour and they come for delivery, I wash the surface of their tum with water. I sometimes effort to straighten the baby up physically if non well positioned. (TBA6F)
Well-nigh of the TBAs used their fingers to estimate the cervical dilatation during labour and predicted time of delivery based on their findings.
…when I bank check and go three fingers and then I have to give food meaning that the time is almost close (TBA14F)
They also assessed the amniotic membranes or flesh of the baby if the membranes are ruptured with their fingers and asserted that the closer the membrane or mankind is to vaginal opening the earlier the adult female would give birth.
...when I cheque and the flesh around the womb is well-nigh the vagina or I see information technology'south near the vagina, it ways she tin give birth correct away. (TBA15F)
Behavior and practices regarding umbilical cord and placenta
A TBA reported that she checked and felt the umbilical string for pulsations. If pulsations were felt, the cord would not be cut until the pulsations diminished. This is to permit the return of the 'spirit', believed to be in the cord, into the baby.
…when the kid is born nosotros hold the cord and check if it is pulsating strongly; that ways the child's spirit has reduced and the spirit is in the cord and if the beating of the cord stops, the kid will exist screaming and crying so it ways the cord is now expressionless and can be cut… (TBA14F)
Few TBAs had clients with retained placenta and in such instances, they gave the adult female a specific leaf to chew.
....when the placenta delays, we accept a leaf that nosotros give to her to chew. She will chew that leaf and it helps the placenta to come out immediately. (TBA14F)
Other TBAs placed a woman with retained placenta on plantain leaves to deliver the placenta.
…we just cut plantain leaves and place information technology on the floor. When y'all place the woman on it, within 5 mins the placenta will come up out. (TBA1M)
After the commitment of the placenta, it was buried co-ordinate to the custom of the private.
We don't merely bury placenta. We have directions for burying placenta considering that is the destiny of the child. (TBA1M)
Some TBAs were of the view that the way the burial of the placenta is done determined what the child becomes later in life.
…when going to coffin the placenta, the part that was cutting from the child must point upwardly. When nosotros plough the string part downwards, the child would become a prostitute in the future. (TBA11M).
Some TBAs believed that they never encountered issues of retained placenta because they offered pregnant women malt and milk before the start of labour.
Since I started this delivering, I accept never delivered any child where the placenta delayed …this is considering when the woman comes, earlier the delivery process, I give them malt and milk which prevents all these issues. (TBA3M)
Word
The finding that TBAs were initiated into their work through apprenticeship from family members or other experienced TBAs, spiritual revelation and dreams or visions corroborated other findings regarding initiation of TBAs or their acquisition of skills [22, 27, 28]. Given that most of the respondents had no formal education, it is imperative that TBAs are formally trained since such knowledge will enable them to recognise early on signs of complications and refer early so that lives can be preserved [27]. Training programs should likewise be fabricated simpler in social club to facilitate easy understanding. Training of TBAs will also promote the use of standard procedures during pregnancy and labour and prevent infections and other related intrapartum and postnatal issues [42, 43].
Furthermore, the finding that spiritual directions or revelations guide practices of well-nigh TBAs resonated that of Adegoke et al. where the roles of TBAs and their spiritual practices during childbirth were linked [19]. The belief by some TBAs that voices originated from the "Holy Spirit" through prayers and directed them in their practice and in the utilize of herbs was attributed to the fact that the respondents were Christians. Such beliefs may not be held by not-christian participants. Revelations of evil acts that crusade a infant's inability to plow in the womb, are rooted in the predominant African belief that occurrences practice not merely accept concrete simply likewise spiritual causes. The finding also confirmed the belief that pregnant women are susceptible to spiritual attacks targeting pregnancy destruction and poor delivery outcomes [27]. Bulk of TBAs reported praying, fasting and performing sure rituals to counteract evil spirits or activities intending to cause negative results of pregnancy or commitment [19]. This finding was reasonable given that about respondents had received no formal training to enable them nourish to obstetric emergencies. Also, since some meaning women in Republic of ghana believe in spiritual influences in pregnancy and childbirth [44], incorporation of spiritual activities could go on to concenter meaning women for their services. Hence, the demand for grooming of TBAs to do proper assessment of women in labour is necessary so that the life of a woman and her baby is not jeopardized.
Findings on infidelity are consequent with the literature where the miracle is linked to prolonged labour, excessive pain during labour, caesarean section or even death [45]. Women suspected of infidelity were compelled to confess [27], using anointed oil for safe commitment. This was one of the reasons that women preferred symphysiotomy because they and so withal had a vaginal delivery [46]. When practices such equally this persist, TBAs could miss the opportunity of timely referral of pregnant women to health facilities. Findings on the use of anointing oil and prayers during commitment are consistent with the literature [28, 39].
Use of artefacts by TBAs in our study are similar to that of Aziato et al., where Ghanaian women enumerated a number of artefacts used in pregnancy and labour [39]. Religion and societal norms take some influence on the TBAs' belief systems as well as their practices [47] and could mayhap explain the concurrent utilization of religious artefacts in the TBAs' practices with respect to pregnancy and delivery.
The study confirmed that the use of herbs is embedded in the practices of TBAs [27]. While some boiled trees bark and sap, others prepared herbs to excrete water and trigger foetal activity and others also ground fresh okro to excrete discharges and realign malpresentation and enema to enhance commitment.
During prolonged labour some of the herbs were chewed with salt while others were used to improve the blood level of women [28]. These herbs when not well treated could serve as a source of infection. Nonetheless, some Ghanaians adopt herbal medicine because of the belief that it is effective and has no side effect [48]. Meaning women may patronize TBAs to obtain herbs. Withal, health professionals practise not utilise herbs routinely for fear that such herbs, for example Cytisusscoparius, may trigger preterm labour, rupture the uterus, and bear on the unborn babe and mother [49, 50].
Most TBAs reportedly diagnosed pregnancy by feeling for an intestinal lump using their fingers as reported in other studies [25]. TBAs used their fingers to assess cervical dilatation and the amniotic membranes. Yet, this is a concern because TBAs scarcely use examination gloves during these assessments or commitment raising a high risk of transmission of infections and the introduction of bacteria from the vagina to the fetus (chorioamnionitis). The TBAs could also handle more than one pregnant woman routinely and could therefore transmit infections from customer to client [28]. The need for the provision of resources for TBAs emphasized.
Delayed cord clamping is considered an international best practise for improving maternal and neonatal outcomes [51]. This shows that although TBAs may not have scientific explanations for some of their practices and endeavor to explain things in metaphysical terms, their practices are not entirely harmful equally portrayed by some professional health practitioners. However, bug could consequence from their failure to recognize danger signs, their disability to implement simple evidence-based interventions for complications, and delayed referral [46]. Information technology is also emphasized that the string should be cut with sterile instruments; hence, TBAs should be educated on this to prevent infections. One challenge encountered by TBAs is birthing of the placenta and burial past the family or in their presence according to their customs. Hadwiger & Hadwiger [52] recorded similar behavior where the spouse buried the placenta at the dripping spot of roof water so that the baby will grow to be intelligent and courteous. This suggests that TBAs understand and respect the religious beliefs of their clients and adhere to their requests. In relation to this, the assertion can exist made that some women would still continue to seek the services of TBAs since they perceive them as people who share in their values and beliefs.
From the study, it is revealed that most TBAs engaged in much trial and error which includes many traditional interventions during delivery. This suggests that services provided past some TBAs in the Kasseh district do not have defined guidelines that decide when they cannot manage a complication and this may atomic number 82 to late referral with fatal consequences [52, 53]. This again calls for the demand of training TBAs to consider early referral in order to salve lives. As compared to other studies where near participants were females [4, 8, 46], we recruited four males indicating that a general socio-cultural preference for female TBAs in sub-Saharan Africa although this is not quickly but gradually irresolute.
The study involved but TBAs of African Christian orientation and perhaps TBAs of other religious systems may take different experiences. Future studies should investigate TBAs with other religious backgrounds to corroborate findings of this study.
The limitation of this study relates to the involvement of but TBAs from the Christian religion because other TBAs from other religions may have different practices that were not captured. Therefore our findings may non apply to other religious groups and comparison should be done with caution. Bias was minimized in this written report through the use of the same research instrument and verification of transcripts using an proficient in Ada linguistic communication. The authors concede that TBAs from other religions and those who have formal education could accept different experiences. Thus, the findings from this written report should exist generalized with caution.
Conclusion
The study revealed different approaches of initiation of TBAs and it was realized that whatever the initiation process, training was necessary to comprise standard procedures in the care of women. The concurrent apply of spirituality, herbs and the opportunity of women to detect or practice their beliefs such as the disposal of placenta attracted women to TBAs' services. Within the socio-cultural context of Ghana where religiosity is a key component of the civilization [44], TBA services will continue to flourish and the employ of some spiritual approaches in tackling maternal health problems may never cease. Information technology is therefore important to train TBAs and provide them with the necessary resources to deliver appropriate services during pregnancy and labour in a holistic fashion, with much emphasis on the areas they find challenging such as cutting of the umbilical cord. A stronger collaboration with health professionals is too necessary to enhance their work.
Abbreviations
- HIV:
-
Human immuno deficiency virus
- TBA:
-
Traditional birth attendant
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Acknowledgements
We are grateful to Annabel Anum for assisting with the literature review for this manuscript.
Funding
Funding was provided by the University of Ghana Kinesthesia Inquiry Fund from the Office of Research, Innovation and Development office (Award # URF/viii/ILG-052/2014–2015) as part of a wider study on influence of spirituality on labour pain management. The funding trunk did not have any influence in the blueprint, data collection and analysis also as the interpretation and writing of the manuscript.
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The transcripts from which this manuscript was developed are available on asking from the corresponding author.
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LA and CNO conceived the thought and wrote the proposal for the written report. LA nerveless the data, LA and CNO analyzed the data. LA drafted the manuscript and CNO reviewed the manuscript. Both authors read and canonical the final version of the manuscript.
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Ethical clearance for the wider study from which this newspaper is drawn was obtained from the Noguchi Memorial Institute of Medical Research at the University of Republic of ghana (NMIMR-IRB CPN 039/xiv-15). Participants gave informed consent to participate in this study by signing the consent form.
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Aziato, L., Omenyo, C.N. Initiation of traditional birth attendants and their traditional and spiritual practices during pregnancy and childbirth in Ghana. BMC Pregnancy Childbirth 18, 64 (2018). https://doi.org/x.1186/s12884-018-1691-7
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DOI : https://doi.org/10.1186/s12884-018-1691-vii
Keywords
- Pregnancy
- Traditional birth attendant
- Traditional practices
- Spirituality
- Childbirth
- Qualitative research
Source: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1691-7
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