The Addition of Traditional Birth Attendant Care to a Home-Based Skilled Nursing Program in Rural Guatemala: A Secondary Analysis from a Quality Improvement Database.

This was a convenience sample from one quality improvement database in rural Guatemala, so the findings may not apply to other settings. The study shows association, not causation. Women who chose traditional birth attendant care may have differed in ways not measured. Traditional birth attendant care and skilled nurse care were given together, so the contribution of each cannot be separated. Birth complications were likely under-recorded because nurses relied on maternal self-report and medical providers rarely shared information. Self-report, recall bias, social desirability, and misinterpretation of questions could have affected the data. Individual consent was not obtained for this secondary analysis.

The authors reported no conflicts of interest, no commercial associations, and no personal or academic conflicts.

Do not read the lower cesarean rate or higher early breastfeeding as proof that adding traditional birth attendant care causes better outcomes. This was an observational quality improvement analysis, and women who saw a traditional birth attendant also received skilled nurse care, so the contribution of each part cannot be separated.