Working with Midwives to Improve Maternal Health in Rural Ghana

M. Kay Matthews, MN, SCM Robert L. Walley, FRCOG, MPH

ABSTRACT
This paper describes the implementation and evaluation of a safe motherhood project in rural Ghana. This project included a partograph and emergency skills program for rural midwives, training and monitoring traditional birth attendants (TBAs), a blood bank and an emergency obstetric transport service. The midwives' roles in caring for women in rural health centres, training and monitoring traditional birth attendants (TBAs) and in emergency obstetric transport are described. In this rural area of Ghana TBAs are responsible for approximately 65% of women in the district during birth. It is important to include them in projects to improve maternal health. The results of process evaluation showed that the rural maternal health system was improved by the project activities through a good communication system, better support for rural midwives, better integration of traditional birth attendants into the health care system and more community involvement. Outcomes included an increase in the number of referrals of women with risk factors and complications to the district hospital, no cases of prolonged obstructed labour in the group of mothers cared for by rural midwives and trained TBAs, a comprehensive recording and reporting system for women cared for by TBAs, and a well established emergency obstetric transport service. Integration of the TBAs into the health care system has had positive effects on TBA practice and morale. However, some TBAs had problems receiving remuneration for their work due to cultural beliefs and practices. The authors conclude that community education and participation are key components of safe motherhood projects.

KEYWORDS
safe motherhood, maternal mortality/morbidity, rural midwives, partograph training, referral of women at risk, traditional birth attendants, emergency obstetric transport

This article has been peer-reviewed.