Maternal Exhaustion as an Obstetric Complication: Implications of TBA Training

Maternal exhaustion is a common diagnosis for Guatemalan women referred to community hospitals by traditional birth attendants (TBAs). Maternal exhaustion is associated with prolonged labor, bearing down for > 2 hours, and oxytocin administration by TBAs. The strongest association is with prolonged bearing down which is a practice commonly encouraged by Guatemalan TBAs. Training TBAs in instructing the mother not to bear down until she has an urge to push and not to administer oxytocin to their patients had little impact in curtailing these practices. This lack of effect may be due to cultural beliefs about appropriate birthing practices and their importance for the women in the community.