Definitions and roles of a skilled birth attendant: a mapping exercise from four South-Asian countries

Objective. To identify which cadres of healthcare providers are considered to be skilled birth attendants in South Asia, which of the signal functions of emergency obstetric care each cadre is reported to provide and whether this is included in their training and legislation. Design. Cross-sectional, descriptive study. Setting. Bangladesh, India, Nepal and Pakistan. Sample. Thirty-three key informants involved in training, regulation, recruitment and deployment of healthcare providers. Methods. Between November 2011 and March 2012, structured questionnaires were sent out to key informants by email followed up by face-to-face or telephone interviews. Main outcome measures. Mapping of definitions and roles of healthcare providers in four South Asian countries to assess which cadres are skilled birth attendants. Results. Cadres of healthcare providers expected to provide skilled birth attendance differ across countries. Although most identified cadres administer parenteral antibiotics, oxytocics and perform newborn resuscitation; administration of anticonvulsants varies by country. Manual removal of the placenta, removal of retained products of conception and assisted vaginal delivery are not provided by all cadres expected to provide skilled birth attendance. Conclusion. Key signal functions of emergency obstetric care are often provided by medical doctors only. Provision of such potentially life-saving interventions by more healthcare provider cadres expected to function as skilled birth attendants can save lives. Ensuring better training and legislation are in place for this is crucial.