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Avoiding home births to reduce maternal deaths in Gedo, Somalia

Binta Ibrahim Somalia

Caption: Traditional Birth Attendant, Binta Ibrahim, with Fatuma Kassim, a new mother she helped refer to deliver at the hospital facility.

Binta Sheikh Ibrahim is one of 25 Traditional Birth Attendants (TBA) who has helped expectant women deliver at home for 15 years now.

This is a skill she learned from her late mother who was a well-known TBA in Luuq, Gedo in southern Somalia.

When mothers experience complications during birth they have no one to guide them on what to do. As a result many mothers die from excessive bleeding and breech births.

You can support more mother’s in Somalia to deliver their babies safely through the Gift of Safe Motherhood.

Referring a patient to the hospital has been Binta’s last resort and most of the time patients die on their way there. Given her frequent emergency visits, she was identified as a perfect trainee for the TBA training which began in August 2014.

Traditional Birth Attendant (TBA) training has the reduction of maternal mortality and morbidity as its strategy. 

Traditional birth attendants are trained to change the focus of their role from providing primary maternity care to becoming supporters and promoters of women avoiding home births. 

“Initially when she would encounter infants lying in breech position she was not sure of what to do and this would lead to the death of either the child or the mother or both”, she remembers.  

Drawing from lessons learned during the training, she accompanies mothers to the delivery room and helps the nurses during the delivery, with labour induction and with giving emotional support to the mother.

“I am happy this way and most of the time expectant mothers are content to accompany the TBA to the clinic,” Binta says. She reiterates that “I will not help any woman to deliver, I offer to accompany them to the clinic instead.”

“I no longer have the biggest responsibility when a mother is experiencing problems during delivery. I am an observer. My major role is to change the attitude and perception towards hospital delivery in Luuq.”

Trained TBAs have adopted this new role; instead of conducting home births and referring women to a facility only at the onset of complications, they accompany mothers to the facility for delivery, antenatal care, or postnatal care. 

Mothers have also accepted this new role, resulting in increased safer deliveries at health facilities. 

The process has met with challenges, however, such as the lack of transport for mothers from their homes to the hospital. Most women have to walk close to three kilometres to and from Luuq hospital.

The town has a military barrier which runs from 6:00am to 6:00pm. Binta remembers, “One time, a mother delivered her baby at the gate of the military camp as she was not be allowed to pass through.” To address these kinds of challenges Trócaire provided a well equipped ambulance to the people of Luuq.

The TBA strategy focuses mainly on urban TBAs and Binta’s desire is for Trócaire to expand and increase health facilities for rural TBAs. She would also want to train other Traditional Birth Attendants and share her knowledge and skills.

On the day I met her, she had brought Fatuma Ibrahim Kassim, a 24 year old expectant mother, to deliver. The delivery was safe and she had a baby girl. 

Fatuma who resides within Luuq town explained that this was her second child and she was happy to deliver at the hospital because she now understands the benefits that come with such a delivery.

You can support more mother’s in Somalia to deliver their babies safely through the Gift of Safe Motherhood.

By Catherine M Waking’a, Trócaire East Africa

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