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Fifty two per cent of deliveries at Ayacucho department (south central Peruvian Andes) occur at home, and at rural settings this number is expected to be higher. The main actor involved with pregnant women in those communities are the traditional birth attendants (TBAs) and they are usually “occult” to foreign people. Some years ago, the health personnel became aware of a new baby when parents came to health facilities asking for a birth certificate for the child. In this context, it becomes evident that an integrated working relationship between health personnel and TBAs was needed: for the health personnel to learn from the TBA's position in the community, and for the TBAs to increase their knowledge about safe pregnancy and referral issues. The picture shows a TBA learning about clean delivery with a simulated baby (connected to the umbilical cord and placenta). Now, both TBAs and health personnel increasingly work together at home and at health facilities.
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