Effect of training on the resuscitation practices of traditional birth attendants

Training programs in more modern methods of birth asphyxia resuscitation were started for traditional birth attendants (TBAs) in 54 villages (population 62,427) of Raipur Rani Block near Chandigarh, India during 1989-1991. A continuing training program by the primary health center staff at 4 focal villages, for one day each month, had been in progress for several years. About 80-100 TBAs attended these sessions. Resuscitation methods included gravity drainage of secretions, physical stimulation by flicking at the soles of the feet, cleaning the mouth by a finger wrapped in gauze, mouth-to-mouth breathing, cardiac massage, and prevention of heat loss by wrapping the baby in multiple layers of cloth. In 1988, 31 TBAs also received advanced training in the use of the mucus extractor and bag-and-mask ventilation. Two trained field workers visited the villages once a fortnight to contact child workers, TBAs and health workers, and checking the local register of vital events to record births. Family members and/or the TBA who assisted at the delivery were interviewed, and a detailed birth history was recorded for stillborn and asphyxiated babies. TBAs assisted with the delivery of 1884 babies (93.7%). Of these, 31 asphyxiated babies and 30 recently stillborn babies were eligible for the resuscitation survey, but information could not be collected for 2 of the stillborn infants. Both traditional and modern resuscitation methods were used in 30 cases (51%), modern methods only in 13 (22%), traditional methods in 2 (3%), and no resuscitation effort was made in 14 cases (24%). Among 21 cases delivered by the trained TBAs, mucus traps and bag-and-mask were used in 33.3% and 42.6%, respectively. Instillation of onion juice and warming of placenta were practiced in a significantly higher proportion of cases by traditionally trained TBAs than by those who had received advanced training. Adoption of modern resuscitation methods by the TBAs demonstrates that they are likely to change their practices.