This study and others has established that the views of these women towards TBAs were based on the fact that TBAs had no formal training and that their practices and medicines were not scientifically approved and therefore threatened both their lives and their unborn babies (Vyagusa, Mubyazi and Masatu 2013; Roost et al. 2004; Bergstrom and Goodburn 2001;
Selepe and Thomas 2000). The women complained about the potential exposure to uncleanliness from TBAs during their pregnancies which could lead to infection or even death.
According to Whitaker (2012), some experts believe women are putting themselves at serious risk by relying on TBAs, who cannot handle obstetric complications such as haemorrhage, eclampsia and obstructed labour, conditions that account for three-quarters of maternal deaths.
Furthermore, untrained TBAs often use unsafe delivery procedures. Practices such as jumping on the stomachs of pregnant women and pulling at their perineum have cost many women and babies their lives.
Similarly, Leedam (1985) claimed that the practices of traditional birth attendants can endanger lives. Even though the participants felt that TBAs might have knowledge in traditional healing methods and preparing traditional medicine, this knowledge was limited. Amounts and ingredients vary for isihlambezo and imbelekisani. Nelie who is a qualified nurse shared that she had heard a colleague talk about two cases where pregnant women in the Mount Frere area were rushed to hospital complaining of stomach aches; it was later found that they had ingested some form of poison which had resulted in the death of their babies. Upon further investigation, it was found that these women had been taking isihlambezo bought from a traditional healer based in town.
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“I would not feel safe being attended to by a traditional birth attendant. I do not hold anything against them, my only concern is that of the health and safety of my baby. I do not trust the practices that they offer and more especially the concoctions that they offer to pregnant women.
I would not want to ingest anything that has not been tested and proven to be safe enough to be ingested by human beings and will not cause any adverse events. Pregnancy is a fragile period and women need to understand this and protect themselves. You cannot go around ingesting medicines that you know nothing about.” – Ondella.
“Over the years, the argument has been that traditional healers in general use practices that put their clients at risk. If I seek medical assistance it is because I need to be assisted and healed, I cannot go to be assisted and come out worse than I was. As a black person I understand the role that traditional healers play in our communities, especially when passing messages from the ancestors to us and so forth; however, I feel that they need some training to be able to heal and treat people’s illnesses and not pose a threat to harm them in the process.
I would not want to put my pregnancy at risk by attending the services of a practitioner that has not been through school and received thorough training. Pregnancy is a vulnerable period where even specialists sometimes diagnose or miss something and complications still occur.
Personally, I would not risk the health of my child by attending a traditional birth attendant.”
– Zukiswa
“The issue with the traditional birth attendants is that they have no formal training. When you are pregnant you need to do your research and find out as much as you can how to best protect your foetus and the best way to ensure healthy development. This is my first pregnancy and to be honest with you, traditional birth attendants are not even an option for me right now. I had a big argument with my mother because she was telling me that I needed to seek the assistance of traditional birth attendants or my baby would present complications during and after the birthing process. When I explained that I would not attend a TBA or even ingest isihlambezo because I felt that these were unsafe practices for me personally, she shouted at me and said that I better pray that the baby does not present with complications. She continued to add that living in a city and having a fancy job does not change the fact that I am a black person who is still very much susceptible to witches and evil spirits, especially since I was working away from home and people back home in the rural areas were already jealous about that. I told her that I would pray that God protects and guides my pregnancy from evil spirits and witches.” – Zingie
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Some of the practices that the participants felt were unacceptable during childbirth included:
giving birth on a dirty surface; lack of hand-washing by the birth attendant; guarding the perineum with the foot; frequent vaginal examinations; and traditional methods commonly used to stop bleeding, such as pressure on the abdomen with hand, knee, stool, or other objects, and methods to hasten delivery of the infant or to expel the placenta, and the use of non- sterilised razors which led to fear of infections and possibly death.
A study by Goodburn, Gazi and Chowdhury (1995) found that traditional birth attendants would tie a tight knot around the abdomen above the uterus, which was believed to prevent the baby from rising up again into the abdomen; some would even stand on the abdomen. This practice is believed to be dangerous resulting in many complications such as decreased oxygen supply to the foetus which may lead to brain damage. The participants felt that traditional birth attendants increased threats that could arise during their pregnancies and they felt that TBAs were unaware of some of the complications that could arise during pregnancy as a result of cross contamination. The importance of glove usage was the main issue raised by the participants as they felt that viruses and other various diseases were passed on if gloves were not used properly. Nelie felt that every health care practitioner should always wear gloves as a precautionary measure to protect not only the patient but the health care practitioner as well.
The participants had heard of TBAs who would conduct vaginal examinations without the use of gloves and felt that this was a serious health hazard.
Studies conducted by Vyagusa et al. (2013) and Ganle (2015) suggested that traditional birth attendants did not have adequate knowledge in the use of protective gear while assisting pregnant women. The studies found that some traditional birth attendants did not wear gloves when conducting vaginal examinations or during the birthing process and some used the same pair of gloves for different deliveries. This can lead to infections and the transmission of HIV.
Vyagusa et al. (2013) argued that TBAs lack knowledge about HIV and the possible risk of infections when assisting with childbirth and other bodily examinations without protective gear.
“Umhhh, my general view is that traditional healers in general do not practice or follow safe health care methods. I hear that throughout the pregnancy they smear some herbs and oils to protect the woman and foetus from bad spirits. My first concern is that the herbs that they use may be harmful and cause complications or even the death of the foetus. Secondly, are they using gloves when they apply these herbs and oils, what if I develop an infection?… As far as
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I am concerned, nothing should be applied to the vagina as it may cause complications unless it is something that has been tested and proven to be safe. I personally would not allow anyone to apply anything inside my vagina especially something that I do not have much knowledge of.” – Nelie
“I read that when you are pregnant your immune system runs lower than usual, therefore, you are fragile to most infections. I do not know what is included in the concoctions that they give to pregnant women, all I know is some of the traditional birth attendants are said to include harmful ingredients that cause complications during the birthing process and are also harmful to the development of the foetus. A mother’s protective instinct kicks in the minute she learns of her pregnancy, and the minute I was told that I was pregnant, I read up on the best health care system that would protect and assist in the development of my foetus.” – Zukiswa
“What I know is that the practices used by traditional birth attendants are not safe … it has been proven that they have contributed to HIV infections through the use of unsterilised razor blades and other practices where multiple people are assisted with one razor to make incisions on their bodies. Not only is this practice unhygienic, it also poses as a threat for harmful incurable diseases. I have never trusted traditional healers because some of them have fake qualifications and operate by scamming people for money. My greatest problem is that they do not have universal practices or medicines, each does as they have learned or have been taught by their ancestors. Pregnancy is an extremely vulnerable period to be taking risks with practitioners that either do not know what they are doing or have no formal training and experience.” – Pamela
“My mother told me that when my aunt was giving birth she was assisted by a traditional birth attendant. Her birthing process was taking longer than usual and they were starting to worry as she looked like she was about to give up. Eventually the baby made some slight movement down and the TBA who was assisting her took iqhiya [doek] and tied it around the upper part of the abdomen so as to push the baby down. As that did not help the TBA apparently asked for a log that was to be placed in the same region as the doek so as to prevent the baby from pushing backwards instead of coming out… After burning incense and pleading with the ancestors the foetus was birthed successfully. My main concern is that so much could have gone wrong, the log and doek could have punctured vital organs inside the mother and damaged the foetus somehow. I would not allow anyone to put logs or tie my abdomen with
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anything as it may make it difficult for me to breath. With proper training I feel that these are some harmful practices that could be prevented.” – Zingie
“I have heard of people dying while being assisted by the traditional birth attendants. I understand that they have no formal training and in case of emergencies do not have a clue of what to do to assist the dying woman. My biggest concern is that they are unable to deal with and treat complications such as bleeding and infections which are life threatening. What happens if I bleed or develop an infection after birth, how will they assist me? The ancestors cannot stop my bleeding nor can they treat my infected new born right after birth.” – Ondella