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.

When treatment turns dangerous: Nigerians’ battle with counterfeit medicines APC gov’ship tickets: Imposition or consensus? 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