In many rural communities in Nigeria, childbirth does not begin in a hospital ward. It begins in a dimly lit room inside a family compound, where an elderly woman sits beside a labouring mother, surrounded by herbs, whispered prayers, spirituality, tradition and years, sometimes decades of experience.
These women, known as traditional birth attendants (TBAs), remain a quiet but powerful force in maternal care in rural communities. Despite the expansion of modern healthcare, they continue to help in the delivery of babies across the country, particularly in rural communities where hospitals are distant, costly, or culturally uncomfortable and most times not available.
But behind their steady hands lies a more complex reality shaped by resilience, sacrifice and a healthcare system that struggles to reach the most vulnerable, especially pregnant women. Weekend Trust spotlights the risks, decisions women make between affordability and survival
In Nigeria, traditional birth attendants (TBA) have been around since time immemorial, bridging the gap in the health care system by saving women and new-borns in remote and underserved areas where formal health care is unavailable or affordable.
According to the 2024 National Demographic and Health Survey (NDHS), only 46 per cent of births in Nigeria were attended by doctors, nurses or midwives.
Ya’Amarja Maduganari, a 58-year-old, is a skilled traditional midwife who, for almost 25 years, has been helping women in local communities to give birth in Maiduguri.
Speaking to Weekend Trust, Ya’Amarja narrated how her journey into becoming a traditional midwife began over 20 years ago.
She said that one fateful night in 2005, her younger sister went into labour at midnight and neither a nurse nor a skilled TBA was available.
“When my sister Fatima started the labour, the nurse and other skilled TBAs that usually attended to pregnant women in our area were not around. So, I tried to assist her, and luckily, she delivered the baby successfully.
“From that first successful trial, other people in the neighbourhood started to call me whenever their wives or daughters were in labour. I have been practising it for the past 20 years.
“In fact, now we have reached a stage whereby whenever a pregnant woman is in labour, whether at night or during the day, most women in our area would prefer to put to bed at home than going to a hospital,” she said.
According to her, even when a woman puts to bed, she advises them to go to a health centre to be examined in order to avoid unforeseen complications.
She also noted that although she received help when women delivered their babies successfully, she decided to see a professional who informally taught her some basic things in child delivery so as not to depend on local knowledge only which she has used over years.
While she hasn’t received any formal training on receiving childbirth, the traditional midwife said she also provided ante-natal services for pregnant women.
Although she is patronised beyond her immediate neighbourhood at Maduganari, she said she didn’t have a fixed amount for childbirth. “I always collect whatever amount given to me because helping a woman to bring a child into this world is itself a blessing,” she said.
She also said she doesn’t use herbs, noting that whenever she is asked to assist a pregnant woman during childbirth, she only reads certain verses from the Qur’an into a cup of water and gives them to drink. “And that has always worked out in helping the women put to bed within a short time.”
Ya’Amarja further noted that in her over 20 years of being in the profession, she only recorded incidents of stillborn or infant deaths twice during delivery.
In instances where mothers encounter challenges after childbirth, she noted, “There are times some mothers have haemorrhages after childbirth, and whenever that happens, I quickly tell their relatives to immediately take them to a hospital to get immediate medical attention to enable them address the situation,” she said.
Malama Ya’Amarja also said that some time ago, they formed an association to sanitise the activities of the TBAs to avoid activities of quacks, who most times begin to practise because of financial gains. “We serve as mentors to ensure that the women they attend to are safe during and after childbirth,” she added.
She appealed to the Borno State Government to support them through training on the basic midwifery skills and delivery kits.
‘I get my medications in dreams’
Interestingly, in Uyo, the Akwa Ibom State capital, Ms Ekomobong John, a traditional birth attendant, attributed her work to a gift from God.
Ms John, who revealed that she makes use of leaves and herbs to help pregnant women deliver safely, said she got some of her medications and prescriptions from her dreams.
Ekomobong, who is in her late thirties and in charge of a traditional midwifery home opposite Ifa Ikot Okpon Health Centre in Uyo, explained that she takes delight in her job because it is her duty to save lives. She revealed that she learnt the skill in Port Harcourt before returning home to assist her late mother, who was the original owner of the traditional birth home.
“This job is not bad; it saves lives. There are cases that hospitals cannot handle and they are most times referred to us here because it is not all cases of pregnant women that involve the use of medicine. There are cases where you use leaves and herbs for the safety of the child.
“I like the job that God has given me. I give some of the women the leaves they use as laxatives. It helps to free the child in the womb. There are instances where pregnant women go to ante-natal and are given treatment; here too, we also have our own special treatment.
“The leaves make it easy for a pregnant woman to deliver safely without complications. The leaves I use are a gift of God,” she claimed.
Ironically, although Ekomobong’s traditional birth home is opposite a government-owned health centre, many pregnant women still flock to her home to be attended to.
However, business has not been very lucrative for Ms John recently as she was yet to handle any delivery in the past two months. She also said her fees were affordable and she has been fortunate not to have recorded any complication as difficult cases are referred to the hospital or handled in prayers.
“We have a lot of women patronising us. The fee is moderate. We don’t charge much because we are interested in saving lives and nothing more.
“I have not had any complications during the delivery process; and no child or mother has died in our care. In the case of difficult childbirth, we also pray.
“However, I had a case where I had to refer a pregnant woman to the hospital because she had already been given some injections from the maternity home that referred her here.
“After delivery, I refer the women to the hospital for postnatal care,” she said.noting that work tools and her delivery Ekomobong also said she was not willing to leave the trade for any other thing. “This line of business is good. And I work full time. I don’t intend to leave it for another job because I would not want any woman who comes here and doesn’t see me to lose her child or her life,” she declared.
‘I inherited the practice from my father’
Some traditional birth attendants in Bayelsa State also said that although the practice is not lucrative, they derived joy in rendering services that help the downtrodden in the society who may not have much resource for hospital bills.
Weekend Trust checks showed that most residents of the state who live in riverine and rural communities patronise traditional birth attendants for delivery.
Madam Salomi Gonibo, who operates a local delivery home in Ayama community, Southern Ijaw Local Government Area of the state, said she learned the practice from her father and has been practising for close to 30 years.
Though originally from Swali community in Yenagoa, she operates in Ayama community because, for her, people in rural communities need the services of traditional birth attendants more than those in urban areas due to limited or lack of health facilities.
According to Madam Gonibo, since she started the practice a few months after the creation of the state in 1996, she has never experienced any casualty in terms of death of either baby or mother.
“Many pregnant women have delivered their babies here. I inherited the practice. My mother’s side was also doing it, but I learnt it from my father.
“If a child unfortunately died in the womb before the mother comes here, I would inform her beforehand. I have handled the delivery of my son’s wife six times and no casualty. I have handled the delivery of four twins and all of them are alive. Sometimes I deliver over 30 children in a year; and no casualty has ever been recorded.
“When a pregnant woman is brought here, I first check if the cervix is open, then I keep them for two to three hours. If I discover that the cervix is not open, I refer them to hospital, but if it is what I can handle, I do it. If the pregnancy enters 9 months, there is a particular herbal medicine I cook for them to eat to make the delivery easy.
“Also, if the cervix is not open, there is a particular tablet we use. For the ones that is difficult for the baby to come out with, there is also an injection that is administered.
“If it is the case of bleeding after delivery, the first thing is to give them Lucozade Boost so that they will not lose strength. If the bleeding is too much, we will buy either full or half crate of coke, turn it into the basin, soak the woman in the basin and pour the other part on her body. The bleeding will stop if a spiritual hand is not involved. The very first thing I do before I start handling the delivery is to pray to God to give me direction.
“I handled a delivery last week and there was no complication, but after delivery, the stomach didn’t go down as it was supposed to; but with God, after a few hours, it went down.
“I combine both traditional and orthodox medications. But for the ones I give native, I don’t give them orthodox medication because they don’t cooperate.
“I don’t charge much here; after delivery, anything you give me I take happily. Some pay N10,000, N15,000. I have never collected more than N20,000.
She advised traditional birth attendants not to force any pregnant woman to deliver when her labour is not due, adding that it is the reason many people think traditional birth attendants kill people.
Also,another TBA, Madam Kiri Kingsley, who operates a traditional birth attendant home at Ebedebiri, Sagbama Local Government Area, said she learnt the practice as a child from her mother, noting that many babies have been delivered in her home without any casualty.
“I started as a young girl, and by God’s grace I have recorded several successful deliveries. We also massage pregnant women and women looking for fruit of the womb.
“We have some herbs we give to fight internal heat that may affect women getting pregnant. We also have what we give those in labour.
“The practice is not for money; it is just service to mankind. It is our contribution to humanity. If there were not traditional birth attendants, what would be the plight of some pregnant women in our rural communities where there are no hospitals and their husbands can’t afford the cost of a hospital in Yenagoa or any nearby town? God placed us here to handle these things and also help the society,” she noted.
Speaking on the issue, a traditional midwife in Ilorin, Osunfunto Abiyeola, said she was born into the practice nearly six decades ago.
She said she inherited the trade from her father, a hunter who also served as a traditional healer.
Now 59 years in the profession, she described traditional midwifery as not just an occupation but a lifelong calling backed by lineage and spiritual conviction with years of experience.
“I thank God for the grace He has used me to achieve,” she said, recalling numerous cases where pregnant women who had been advised to undergo surgical delivery were eventually delivered safely under her care.
She, however, expressed disappointment over unfulfilled promises by some beneficiaries.
“Some people promised to build a house for me or support me if their wives delivered safely when they were brought to me, but they never came back.”
She recounted a recent case involving a woman brought from Warri in Delta State who was to be operated on but eventually delivered safely after undergoing a combination of prayers, prescribed herbs and close monitoring for about 15 days.
Despite such outcomes, she noted that financial returns are inconsistent.
While she charges about N50,000 per delivery, some clients are unable to pay, often citing financial constraints.
“The two systems complement each other. It is God who gives us the wisdom to interpret medical results through experience,” she said.
She explained that herbs used in her practice are sourced from the market or gathered fresh from the bush, depending on availability and the specific case.
She noted that spiritual support also plays a central role; provided by her husband, an Alfa, who assists with prayers while she handles the physical process of delivery.
Their son has also since joined the practice.
Abiyeola added that beyond childbirth, her services extend to women seeking fertility solutions and treatment for certain ailments such as chronic cough. Her clinic operates mainly on Sundays, and she claims not to have recorded any death during childbirth in her facility over the decades, attributing this to divine intervention and strict adherence to her methods.
Before venturing into traditional midwifery, she said she was into farming and soap making but found little success, reinforcing her decision to remain in the profession she inherited.
In Kano, at nearly 65, Hajiya Binta has spent over 30 years delivering babies in Bechi, Kumbotso Local Government Area.
“I learned this work from my mother,” she says. “I started by assisting her before I began mine.”
Her tools are simply warm water, cloth, and locally prepared herbs, some boiled into mixtures believed to ease labour or “strengthen the womb.”
Baba Larai, 71, from Kadawa in Ungogo, still remembers losing her first child during childbirth.
“That is what pushed me into this work,” she says quietly. “I didn’t want other women to go through what I went through.”
Today, with nearly two decades of experience, she blends herbal knowledge with spiritual practices through recitation of prayers and use of protective verses during difficult deliveries.
In urban Kano, the setting may be different, but the reality remains the same.
Hajiya Tabawa Ta Annabi, 69, has worked in Tukuntawa for twenty-five years.
“Women still come because hospitals are expensive and stressful,” she explains. “But when I see danger, I refer them.”
Traditional midwives operate with little more than experience and instinct. Their ‘equipment’ often includes herbs such as neem leaves, scent leaf, bitter leaf, and ginger mixtures, alongside basic items like cloth, bowls of water, and razor blades used to cut the umbilical cord.
Interestingly, not all TBAs are elderly. In Mandawari, Gwale Local Government Area, Malama Zainab, in her early 40s, represents the younger generation trying to keep the practice alive.
“I learned from an elderly woman and most of my work happens at night.” She notes
Her working conditions are stark, with no electricity, improvised delivery spaces, and sometimes the use of nylon as makeshift gloves.
“Sometimes you just pray nothing goes wrong,” she admits.
For most TBAs, midwifery is not a dependable source of income.
They earn between 500 and 10,000 per delivery. In many cases, payment comes in the form of food, grains, or small gifts. Some are not paid at all.
“This work does not give steady money,” Hajiya Binta says. “I farm and sell herbs to survive alongside midwifery.”
“You can be sleeping and they wake you up. You must go.” A midwife noted.
She added that the work is demanding both physically and emotionally.
“Most TBAs are ageing, battling back pain, poor eyesight, fatigue and constant exposure to infection due to lack of protective equipment. But the emotional burden runs even deeper.
“When a baby dies, you don’t sleep for days. People blame you.”
‘Why we patronise local birth attendants’
Despite the risks, many women continue to rely on TBAs, not out of ignorance, but necessity.
Aisha, a mother of three, puts it simply, “They treat you like family. In the hospital, they shout at you.”
For Zainabu, a young mother, the issue is cost. “I cannot afford hospital bills. Here, I can pay little money.”
Other reasons include cultural familiarity, trust, proximity and in some cases, the absence of female healthcare workers in nearby facilities. However, experiences among women who patronise traditional birth attendants vary.
In Illorin, Mrs Oyinda Abdul said she was introduced to a traditional midwife by her younger siblings and initially had a smooth experience.
“It didn’t take long before my baby was delivered, to the surprise of my family,” she said.
But she expressed reservations based on a later experience that ended tragically.
While she had successfully delivered a child at a traditional facility, complications during her last delivery there led to the loss of the baby.
“We later discovered that the child hit her head on the ground during the process of delivery, which really affected her,” she said.
“We eventually lost her due to the complications and memory loss. It was very challenging time for us”, she added.
According to her, while some practitioners are competent, others have “bastardised the profession” by taking on cases beyond their capacity instead of referring patients to hospitals when complications arise.
Similarly, Madam Toyin Abdullahi, who delivered four of her six children through traditional methods, maintained that traditional and modern systems can coexist if properly regulated.
She said her decision to use a traditional midwife was influenced by her first hospital experience, where she was advised to undergo surgery due to insufficient dilation.
“My husband refused to sign for the operation, so we consulted relatives and went to a traditional midwife,” she recounted.
At the facility, she was given various herbal preparations, including soaps for bathing, substances for body application and mixtures to be taken at different stages of the delivery process once admitted.
Some of the prescribed meals, she noted, were difficult to consume due to their bitter and unusual composition including snails and worms.
“Upon arrival at the traditional facility, a series of herbal preparations were introduced as part of the process.
They gave me different traditional soaps. One for bathing, another to rub on my stomach, and a separate one prepared specifically for use on the day of delivery,” she said.
Despite the structured process, she admitted that some aspects of the treatment were physically and emotionally demanding, particularly the dietary prescriptions.
She further described the procedure carried out during labour, noting that it was unconventional but, in her case, effective.
“On the day I was to deliver, they inserted something into my body that expanded it and helped the process. Since then, all my children, the six of them, were delivered without any operation, contrary to what the hospital initially told me during my first pregnancy”, she said.
Over time, however, financial considerations influenced her return to hospital deliveries, as the cost of traditional care rose above N50,000, compared to less than N20,000 at the hospital at the time.
Despite her preference for traditional methods, she acknowledged the role of some level of modern medical input within such settings, including basic examinations, drug prescriptions and tests to monitor pregnancy.
“For me, I would not say they should be scrapped. People should choose based on their experiences, but the government should regulate both systems so they can coexist safely,” she said.
Other women who patronise traditional birth attendants told Weekend Trust that they preferred to put to bed in their hands because they are easily available and cheaper than hospitals.
Maimuna Modu, a mother of five who delivered four of her children at home, said although she is educated and knows the risk of putting to bed at home, “sometimes we don’t have much options because there is no functional hospital in the Maduganari area and traditional birth attendants are more friendly, accessible and cheaper.”
She said, “During my second pregnancy, my husband had travelled and there was no hospital nearby, so I had no option but to call a traditional birth attendant. Within 30 minutes, I delivered my child without complications. From that time, although I attended all the ante-natal sessions in hospital, all my other three children were delivered at home.”
A resident in Bayelsa, Mrs Ebiere Elvis, said the cost of the services of traditional birth attendants was more affordable than what obtained in hospitals, adding that it is helpful to rural dwellers.
“I have five children; and had all of them at a traditional birth attendant’s home without any complication. Another reason traditional birth attendant’s home delivery is good is that it saves cost. If I can pay N10,000 to deliver, why should I go to a hospital that may collect up to N100,000 for the same delivery?
“Besides, they also massage pregnant women to make delivery smooth, which is what our forefathers did,” she said.
‘Use of TBAs increases risk of preventable deaths’
Health experts say the persistence of TBAs reflects deeper systemic gaps.
Dr Musa Sani, a public health specialist, offers a balanced view on the matter.
“Traditional birth attendants are not the enemy. They fill a gap where the health system is weak.”
But he warns of the risks involved in the process.
“When complications rise, they lack the skills and equipment to handle emergencies.”
His recommended engagement, not exclusion. “We should train and integrate them into the healthcare system so they can recognise danger signs early and refer cases promptly.”
In an interview with Weekend Trust, a medical doctor, Dr Godwin Ekuwke, warned that the continued patronage of traditional birth attendants (TBAs) in Nigeria significantly increases the risk of preventable maternal and newborn deaths.
According to him, “many women underestimate how quickly a normal pregnancy can turn into an emergency. The problem with TBAs is not just lack of formal training, but the inability to respond effectively when things go wrong.”
Ekuwke explained that while some TBAs have experience, childbirth complications often require rapid medical intervention that only equipped health facilities can provide.
He identified haemorrhage, prolonged labour, and hypertensive disorders as major risk factors that are poorly managed outside clinical settings.
“A woman can bleed to death within a very short time after delivery if there is no access to blood transfusion or emergency care. In a proper medical facility, there are protocols, drugs, and surgical options. In most TBA centres, those life-saving measures are simply unavailable,” he said.
Contributions from Abbas Tijjani Madabo, Kano, Mumini Abdulkareem, Ilorin, Bassey Willie, Yenagoa, Iniabasi Umo, Uyo &Haruna Gimba Yaya, Maiduguri.