Characteristics of traditional midwives and their beliefs and practices in rural Bangladesh

Abstract

This study has analyzed the characteristics, beliefs and practices of midwives in rural Bangladesh. The midwives were mainly above age 30, married or widowed, and illiterate. Most of them learned their midwifery from informal sources such as female relatives or neighbours. Often, during pregnancy, childbirth, and post-partum period, midwives imposed dietary restriction on the mothers. Similarly, devices used in the cutting of the umbilical cord and placenta were not properly sterilized and potentially dangerous substances were applied at the navel after cutting the umbilical cord or placenta. There was a practice of withholding breast-feeding up to 3 days after the birth of a child. However, there were also some beliefs or practices among the midwives that could be regarded as based on scientific understanding such as the practice of cutting the umbilical cord by boiled razor blade or the belief that child death could occur from tetanus caused by the unsterilized device used in the cutting of the umbilical cord.

PIP: The characteristics, beliefs, and practices of 242 traditional midwives in rural Bangladesh were analyzed using a data set collected by Christian Commission for Development in Bangladesh (CCDB). A large majority of midwives were older than 30 years and were either married or widowed; 79.7% were illiterate. The midwives learned their midwifery from informal sources in which mother to mother-in-law was the most frequently cited source (41.0%), followed by sister or cousin (16.5%), and grandmother (15.7%). Other less frequently mentioned sources of experience were neighbors (11.9%), other relatives (7.5%), or self-taught (7.4%). About 45% of the midwives were doing midwifery for more than 9 years and the remainder were practicing for 9 years or less. During pregnancy and the postpartum period, various dietary restrictions were imposed on the mothers, which deprived them of some nutritious ingredients such as fish or meat. Often the devices used in cutting the umbilical cord or the placenta were not properly sterilized, potentially dangerous to the life of both mother and child. There also was a practice of withholding breastfeeding up to 3 days after the birth of a child, depriving the child of both nourishment and the vital substances for the child's immune response system. Some beliefs or practices of the midwives could be regarded as based on scientific understanding. The practice of cutting the umbilical cord by razor blade rather than traditional bamboo sheath or the practice of washing the umbilical cord cutting device in hot water could reduce infection. Some nonharmful rituals and practices observed by the midwives could ease and facilitate childbirth by providing a sense of social and psychological security to the mother. The study reveals that the midwives lacked basic knowledge about physiological processes during labor and childbirth, the basics of the sterilization of umbilical cord cutting or placenta cutting devices, and necessary nutrition intake during pregnancy. An appropriate training program is likely to improve maternal and child survival in rural Bangladesh.