<b>The Primary Roles of Traditional Birth Attendants in Childbirth Support: Contemporary Perspective from Nigeria</b><b></b>

Traditional Birth Attendants (TBAs) continue to play a vital role in maternal healthcare in Nigeria, especially in rural and underserved areas where access to formal health services remains limited. Their culturally rooted practices, affordability, and accessibility have sustained their relevance despite increased efforts toward skilled birth attendance. This study explores the primary roles of TBAs in childbirth, focusing on their practices, perceptions, and integration within the contemporary healthcare system in in Ikwerre Local Government Area, Rivers State, Nigeria. A cross-sectional mixed-methods approach was employed, combining quantitative and qualitative data. A purposive sample of 80 TBAs and 40 skilled birth attendants (SBAs) including nurses and midwives participated. Data collection tools included structured questionnaires, focus group discussions (FGDs), and key informant interviews (KIIs). Quantitative data were analyzed using SPSS v25, while qualitative data underwent thematic analysis. Findings showed that 85% of TBAs were women aged 45 years and above, with over 10 years of childbirth experience. Most (70%) acquired their skills informally through older relatives. TBAs reported key roles including labor support (90%), delivery assistance (78%), herbal remedy use (64%), spiritual care (58%), and postpartum support (72%). Qualitative data revealed TBAs viewed their roles as holistic and culturally aligned. Although 75% had never received formal training, many expressed willingness to collaborate with health institutions. SBAs acknowledged TBAs' community trust but raised concerns over hygiene, referral delays, and infection control. Despite the health system's modernization, TBAs remain culturally and functionally indispensable. However, their lack of formal training presents challenges to maternal safety. Integrating TBAs through structured training, respectful engagement, and functional referral systems is critical to improving maternal outcomes and aligning with global health goals. Strengthening this synergy holds promise for a more inclusive and responsive maternal healthcare system in Nigeria.