Almost half of all Tanzanian women deliver at home, alone, assisted by family members or traditional birth attendants. The aim of this article was to expand existing knowledge on how pregnant and laboring women’s preferences and decisions of birth place and type of assistance are influenced. A qualitative study with semi-structured interviews, with two traditional birth attendants and one midwife, and a participatory observation was conducted at a health clinic in Tanga District, Tanzania. It was found that the interaction between pregnant women and birth attendants is significant to the womenŽs preferences and choice of birth place and type of assistance during labor. The traditional birth attendants have a high social position and are available in the villages. The financial burden attached to a professionally attended birth is at the same time reduced with the choice of a home delivery. It appears that scarcity of recourses within the maternal care reinforces ethical dilemmas and negative behavior among health personnel, which influence women’s preferences of birth place and assistance in labor and consequently maternal health and safety.

Keywords: birth assistance, home delivery, maternal mortality rate, maternal care, maternal health