A sense of pride sweeps through Mary Napolo Sankale whenever she comes across young children and teenagers in the village of Enaibor Enajijik, Narok county. Mary, 55, a traditional birth attendant, has lived in the village her whole life, attended to numerous pregnant women and helped deliver many babies. She acquired the skill from her maternal grandmother when she was a young girl. Even though she cannot recall exactly when she started practising traditional midwifery, some of the older children she helped deliver are now in high school while the youngest is an infant born the previous week.
Her practice has evolved over the years. Previously, her thatched hut served as the maternity ward. During home deliveries, she helplessly watched women undergo birth complications. “My skills were limited and the tools outdated. When mothers bled excessively, all I could do is slaughter a sheep, feed the mothers with the blood and hope that they would be okay,”she says. But since 2014, Mary directs pregnant women who seek her services to a nearby dispensary where they can benefit from skilled deliveries. She is among traditional birth attendants trained by the Narok County government and National Integrated Development Programme, a local non-governmental organisation that works in collaboration with health facilities to promote skilled deliveries and reduce maternal deaths.
“Deep in the remote areas of Narok county, where health facilities are sparse, traditional birth attendants (TBAs) served as the only alternative for some expectant rural women. Even in places where there were health facilities, women still preferred TBAs as they had earned the trust of the community,” says Caroline Saitoti, Reproductive Health Coordinator, Narok East sub-county. In the hands of the highly revered unskilled traditional birth attendants, women risked getting complications such as obstructed labour, fistula, post-partum haemorrhage, sepsis or dying.
Under the county and NIDP, traditional birth attendants were trained on the need to refer expectant women in labour to the nearby facilities. Due to the close relationship the TBAs enjoy with the community, they easily identify pregnant women at the onset of the pregnancy and direct them to health facilities for antenatal visits. TBAs learn to detect dangerous symptoms in pregnancy and take expectant women to health facilities. They also receive equipment such as surgical gloves, blades and cord clamps to safely help in childbirth in case of an emergency. “Women travel long distances to access the health facilities. Some end up delivering along the way. Fortunately, the trained TBAs are there to attend to them,” says Rahab Mwangi, nurse in charge, Enaibor Enajijik dispensary. Since Mary became a mother’s companion, she has accompanied many women to the dispensary for skilled deliveries and improved newborn care. “After delivery, the dispensary and TBAs conduct postnatal follow-up to ensure mothers receive treatment for any complications that may arise and encourage mothers to bring children for immunisation,” says Rahab. To motivate them, TBAs receive Sh500 for every mother they accompany to the hospital for delivery. Traditional midwifery served as a source of livelihood for them as they would be paid for their services in form of goats and sheep.
To encourage more skilled deliveries, the county government gives a motherpack to every mother delivering at a heath facility. The motherpack comprises a basin, towel, lesso, and sanitary towel and bathing soap.Collaborations between traditional birth attendants and skilled health workers has increased hospital deliveries and decreased maternal deaths. “In 2014, we attended to only five women the entire year. Today, we receive at least five women in our facilities every month,” says Rahab. On the other hand, traditional birth attendants continue to hold their esteemed position in the community for caring for pregnant women, earn a livelihood and improve maternal health. At the end of the day, everyone benefits.