TBAs in rural Northeast Brazil: referral patterns and perinatal mortality

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Abstract
This paper examines factors affecting hospital referral by traditional birth attendants (TBAs) and the impact of both TBA assistance and hospital intervention on birth outcome. In the county of Traini, Brazil, 139 of 1057 women seen by TBAs over the course of a year planned to deliver at home but were referred to a hospital. An additional 119 women gave birth at home without the assistance of a TBA. Adjusted odds ratios showed that referral rates were significantly higher for women in the following groups: first delivery, 35 years and over, antenatal pathology, malpresentation, previous caesarean section, multiple birth, and lower caseload of TBA. Although TBAs identified and referred most high risk women, hospital intervention did not have a statistically significant impact on the survival of infants born to women most likely to be referred. Reporting problems may have reduced significance levels. For home deliveries, survival status was not significantly affected by the presence of a TBA.

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