Access to skilled care at home during pregnancy and childbirth: Dhaka Bangladesh

In Bangladesh the majority of childbirth takes place at home by unskilled persons. The objective of this study was to strengthen maternity care services through provision of skilled midwives and to explore people's perception of skilled birth attendants. As part of a quasi-experimental community trial conducted among selected urban area of Dhaka city, a group of skilled midwives were posted in selected urban centers between January to December 2002 to provide obstetric care services and some social mobilization activity in the community. Analysis of skilled midwives self-reported case records and monitory reports of the researchers was done on selected themes. The perception of the skilled midwife was not clear to people. They thought traditional birth attendants who conducts delivery over years were skilled midwives. Preparedness for obstetric emergency and birth planning was non-existent in the families. The skilled midwives were well accepted in the community but discouraged by center authority for home birth, apprehending that it will reduce their client flow and earning. Non-cooperation by other health care providers was common.