title: Maternity waiting homes and traditional midwives in rural Liberia.
abstract: OBJECTIVE
  Maternity waiting homes (MWHs) can reduce maternal morbidity and mortality by increasing access to skilled birth attendants (SBAs). The present analysis was conducted to determine whether MWHs increase the use of SBAs at rural primary health clinics in Liberia; to determine whether traditional midwives (TMs) are able to work with SBAs as a team and to describe the perceptions of TMs as they engage with SBAs; and to determine whether MWHs decrease maternal and child morbidity and mortality.
  
  
  METHODS
  The present analysis was conducted halfway through a large cohort study in which 5 Liberian communities received the intervention (establishment of an MWH) and 5 Liberian communities did not (control group). Focus groups were conducted to examine the views of TMs on their integration into health teams.
  
  
  RESULTS
  Communities with MWHs experienced a significant increase in team births from baseline to post-intervention (10.8% versus 95.2%, P<0.001), with greater TM engagement. Lower rates of maternal and perinatal death were reported from communities with MWHs.
  
  
  CONCLUSIONS
  The reduction in morbidity and mortality indicates that the establishment of MWHs is an effective strategy to increase the use of SBAs, improve the collaboration between SBAs and TMs, and improve maternal and neonatal health.
authors.affiliation: Division of Health Promotion and Risk Reduction, School of Nursing, University of Michigan, Ann Arbor, USA. Electronic address: jrlori@umich.edu.
authors.forename: Jody R
authors.initials: JR
authors.lastname: Lori
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Munro
authors.forename: Sarah
authors.initials: S
authors.lastname: Rominski
authors.forename: Garfee
authors.initials: G
authors.lastname: Williams
authors.forename: Bernice T
authors.initials: BT
authors.lastname: Dahn
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Boyd
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Moore
authors.forename: Walter
authors.initials: W
authors.lastname: Gwenegale
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D007988:Liberia; D008427:Maternal Health Services / Q000458:organization & administration*; D008428:Maternal Mortality; D008875:Middle Aged; D008880:Midwifery / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000458:organization & administration; D012112:Residential Facilities / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population
keywords: Liberia; Maternal mortality; Maternity waiting homes; Midwifery