How can we improve care for pregnant women who don’t speak English as a first language?

The latest confidential enquiry by MBRRACE-UK, published today, focuses on the care of recent migrant women who did not have English as a first language, and who experienced a stillbirth or neonatal death. The research reviewed babies that died in 2022.

The report states that the overwhelming majority of women whose baby died could have had improvements to their care (96%), and tragically in almost 7 in 10 cases this may have made a difference to the outcome. This means that, with different care, the baby may have survived or the mother may not have suffered physically or psychologically.

Why is the focus of the report on the care of migrant women with language barriers?

The latest figures from the Office of National Statistics show that almost 1 in 3 women who give birth in England and Wales are born outside the UK. This is the highest on record.

According to research, migrant women, especially those seeking asylum and refugees, experience maternity services and care differently. This is due to unfamiliarity with the system, and barriers including limited English-speaking abilities. Services therefore need to adapt to provide the safest care possible for all women.

How can we improve care for pregnant women whose first language is not English?

Two speakers from our recent National Maternity Safety Conference have experience in this area both personally and professionally: Khalood accessed maternity services after moving to the country in 2011 and now works for the NHS, and Angie Doshani is a Consultant Obstetrician and Founder of the Janam App. The Janam App has been designed to address educational, cultural and social barriers in pregnancy and the postnatal period by providing culturally sensitive information in six languages to South Asian women.

We asked them what needs to be considered by health professionals to improve care for women who do not speak English as their first language.

Their key messages are:

1. Body language

“Healthcare professionals should pay attention to a woman’s body language. Body language plays an important role in determining unpleasant events.” (Khalood)

2. Time

“Appointments with doctors and midwives can be very overwhelming. Especially if women do not know their surroundings in a different country. Give her time, make her feel comfortable, listen to her. Have a two-way conversation rather than bombarding her with all the information all at once.” (Khalood)

3. Appropriate information and communication

“Women with limited English proficiency are at higher risk if interpreting services are not offered, as they may struggle to fully understand their care, which can impact their health outcomes. Providing appropriate language support is essential, as many individuals speak multiple regional languages with varying fluency. For example, someone from India may understand some Hindi but speak Gujarati more fluently.

Providing information that is both linguistically appropriate and culturally sensitive is crucial. This involves ensuring that individuals have adequate time to process the information, fully understand it, ask questions, and engage in discussions before arriving at an informed decision. This approach not only respects their language needs but also acknowledges the cultural context that may influence their understanding and decision-making process.” (Angie)

4. Pay close attention to any clues that everything might not be ok

“Every woman during pregnancy is at a vulnerable stage. Not everyone will open up and mention their mental health. Paying close attention to any clues could help support a woman with perinatal and postnatal depression, and this will improve the quality of care towards their babies too.” (Khalood)

5. Make interpretation services more accessible

“Access to interpreting services can involve long waits or situations where the person is not available due it being out of hours. We need to make services more easily accessible to help prevent urgent situations from becoming emergency situations.” (Khalood)

6. Make interpretation services more appropriate

“Interpreters should be trained in perinatal anatomy and specific related conditions to ensure accurate and relevant communication, as general health translations may not cover these specialised topics.” (Angie)

7. Trust-building between health professionals and women

“Recognising and respecting the cultural backgrounds, values, and potential trauma of the communities we serve. Building continuity of care fosters trust and ensures that care is consistent, personalised, and supportive. Avoid making assumptions; instead, take the time to ask questions and actively listen to understand their perspectives, needs, and past experiences.” (Angie)

At Baby Lifeline, we are striving to improve our educational content for the thousands of health professionals we train every year in areas of avoidable harm and death in maternity care. We are grateful to MBRRACE-UK for another informative report on what needs to happen to improve services and care, and we will implement this learning into our own work.

Our Mind the Gap report, published in 2021, showed that just 1 in 5 organisations included scenarios involving women whose first language is not English in their emergency skills & drills training. In addition, fewer than 3 in 4 organisations considered their local population needs when deciding training priorities. There are training gaps that need to be addressed as part of the ongoing improvements for all women, birthing people and babies accessing maternity services in the UK.

Research in this blog: