Unilateral collaboration: The practices and understandings of traditional birth attendants in southeastern Nigeria.

Background: Despite the promotion of hospital-based maternity care as the safest option, for less developed countries, many women particularly those in the rural areas continue to patronise indigenous midwives or traditional birth attendants. Little is known about traditional birth attendants' perspectives regarding their pregnancy and birth practices. Aim: To explore traditional birth attendants' discourses of their pregnancy and birthing practices in southeast Nigeria. Method: Hermeneutic phenomenology guided by poststructural feminism was the methodological approach. Individual face to face semi-structured interviews were conducted with five traditional birth attendants following consent. Findings: Participants' narratives of their pregnancy and birth practices are organised into two main themes namely: 'knowing differently,' and 'making a difference.' Their responses demonstrate evidence of expertise in sustaining normal birth, safe practice including hygiene, identifying deviation from the normal, willingness to refer women to hospital when required, and appropriate use of both traditional and western medicines. Inexpensive, culturally sensitive, and compassionate care were the attributes that differentiate traditional birth attendants' services from hospital-based maternity care. Conclusion: The participants provided a counter-narrative to the official position in Nigeria about the space they occupy. They responded in ways that depict them as committed champions of normal birth with ability to offer comprehensive care in accordance with the individual needs of women, and respect for cultural norms. Professional midwives are therefore challenged to review their ways of practice. Emphasis should be placed on what formal healthcare providers and traditional birth attendants can learn from each other. (C) 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.