Delegation of obstetric care in Indonesia.

An intervention and a control area were selected. Results of the intervention, which consisted of training TBAs, midwives, and health center doctors, were positive inasmuch as there was an increase in referrals of breech presentation, prolonged labor and intrapartum fever in the intervention area. Pregnant women in general were also more often referred in the intervention area as compared to the control area. The same outcome was seen in referrals of neonates weighing under 2000 or more than 4000 g. At the district hospital level, a great number of procedures were left to general practitioners with quite satisfactory results. Conclusions drawn from our experience are that: (1) obstetric care must of necessity be delegated to TBAs, midwives, and general practitioners; (2) TBAs can be taught to recognize danger signs; (3) general practitioners are able to do such procedures as curettage, vacuum or forceps deliveries, and manual removal of placenta.