The role of unorthodox and traditional birth care in maternal mortality.

Many pregnant women see unorthodox medical providers in labour before presentation to the modern medical facilities after obstetric complications have arisen. This study evaluates the contribution of unorthodox medical facilities to the delays subsisting maternal mortality in a rural, poor and illiterate community. Data was collected prospectively on all referrals from outside the St. Vincent's hospital, over a three-year period. Seven hundred and fifty women were referred to the hospital and there were a total of thirty maternal deaths out of the 1268 live births, giving a maternal mortality ratio of 2366/100,000. Most of the referrals were patient-driven and verbal and came from traditional birth attendants (TBAs). The majority of the patients (86.7%) came in poor clinical conditions and some were moribund. The TBAs contributed most to maternal deaths. Prolongation of labour for more than 24 hours correlated positively with maternal mortality. Ruptured uterus complicating obstructed labour (34.8%) and haemorrhage (30.4%) were the leading causes of death in this series. The mortal delay suffered by pregnant women in accessing unorthodox medical attention deserves further attention in issues of maternal mortality in the underserved rural communities of Nigeria.