Background: The essence of training traditional birth attendants (TBAs) is to attend to
women in uncomplicated labor and to refer them immediately to hospitals when complications
develop. Aim: The aim was to audit childbirth emergency referrals by trained TBAs to a
specialist hospital in Enugu, Nigeria. Subjects and Methods: A retrospective study of 205
childbirth emergencies referred to Semino Hospital and Maternity (SHM), Enugu by trained
TBAs from August 1, 2011 to January 31, 2014. Data analysis was descriptive and inferential
at 95% confidence level. Results: Most of the patients (185/205, 90.2%) were married
and (100/205, 48.8%) had earlier booked for antenatal care in formal health facilities. There
were obstetric danger signs or previous bad obstetric histories (pregnancies with unfavorable
outcome) in 110 (110/205, 53.7%) women on admission at SHM. One hundred and fifteen
(115/205, 56.1%) women walked into the hospital by themselves while 50 (50/205, 24.39%)
could not walk. The fetal heart sounds were normal in 94 (94/205, 45.6%), abnormal in
65 (65/205, 31.8%) and absent in 42 (42/205, 20.4%) of the women on admission. Five
healthy babies were delivered by the TBAs before referring their mothers. Delays of more
than 12 h had occurred in 155 (155/205, 76.6%) of the women before referrals. Prolonged
labor (100/205, 48.8%), obstructed labor (40/205, 19.5%), attempted vaginal birth after
previous cesarean delivery (40/205, 19.5%) and malpresentation (30/205, 14.6%) were the
common indications for referrals. The maternal mortality and perinatal mortality ratios were
610/100,000 live births and 228/1000 total births respectively. Conclusion: Delays at TBA
centers are common before referral and most patients are referred in poor clinical state. Further
training and re‑training of the TBAs with more emphasis on recognition of obstetric danger
signs and bad obstetric histories may help in screening high‑risk patients for prompt referral
to hospitals before complications develop.