A Delphi Study of Expert Consensus on Best Practices for Traditional Birth Attendant Support in Maternal Health Systems

Traditional Birth Attendants (TBAs) continue to serve as critical maternal healthcare providers in rural and riverine communities of Nigeria, particularly where access to skilled birth attendants remains limited. Despite the expansion of formal healthcare services, over 60% of deliveries in some regions still occur under the supervision of TBAs (WHO, 2022). However, gaps in infection control, emergency referral, and obstetric management underscore the urgent need for a structured mentorship model that aligns traditional birthing practices with evidence-based maternal care. This study employed a qualitative Delphi consensus approach to gather expert opinions on best practices for strengthening TBA support systems in Rivers State, Nigeria.A purposive panel of 25 experts such as six TBAs, five midwives, four obstetricians, three community health extension workers (CHEWs), and four reproductive health policymakers, participated in three iterative Delphi rounds. Data from Round One were thematically analyzed to identify key domains, while Rounds Two and Three utilized a 5-point Likert scale to establish consensus. Consensus was defined as ?70% agreement among panelists. An 88% response rate was achieved (22/25 participants). Thematic analysis revealed five major domains for effective mentorship: infection prevention and aseptic technique; emergency referral and transport systems; communication and respect for cultural birthing practices; supervision and supportive monitoring; and continuous training with feedback mechanisms. Consensus was achieved on 30 of 38 statements (79%), with the strongest agreement on TBA integration into community health systems (95%), infection control and emergency referral training (91%), and cultural respect (89%). The validated mentorship model comprised four key components: foundational training, supervised practice, referral and feedback systems, and structured monitoring and evaluation. This study provides a contextually grounded, evidence-informed mentorship framework for TBAs, serving as a bridge between traditional and formal maternal healthcare. Its implementation is expected to strengthen collaborative maternal health delivery, enhance safety outcomes, and contribute to achieving Sustainable Development Goal 3 on reducing maternal mortality in Nigeria.