: Claire Jaquin, midwife
: TBAs: give tradition a chance
I have just finished reading the article A dying breed
about traditional birth attendants (TBAs) in Cambodia and feel extremely saddened that they are no longer allowed to practice. Although they have little, if no, equipment, and no formal training, these TBAs are an essential part of Cambodian maternity care. If we compare their skills to those of western midwives, I am sure there will be strong similarities, alongside differing practices.
I sincerely hope the Cambodian Ministry of Health includes TBAs to tackle the problem of high maternal mortality as I believe completely outlawing them will only lead to further problems such as a lack of willingness to travel to a medical centre and non-belief in medical practitioners.
If we consider maternity care in the UK over the past 100 years, it has shifted from a high home birth rate towards predominantly hospital births, and only now are we regretting this shift as the advantages of home birth are being forgotten by both women and midwives, at a great cost to the NHS.
Cambodia therefore must not lose the skills of the TBAs attending home births by forcing all women to go to a medicalised facility to give birth. The many health benefits of home births for women and their babies must be considered and TBAs provided with training and equipment so their culture can be preserved and morbidity and mortality improved. This is certainly not an easy task, but one that must at least be tried before western medicine takes over the natural birth process completely.