Lost in translation: we need to think about language barriers in healthcare

Bringing life into the world is one of the most exciting, special and joyous moments for new parents. However, for some families the process of childbirth and delivery may be clouded with the memory of anxiety, confusion and heartache as a result of preterm delivery or birth complications.

The inspiration for my perspectives project came from my own experiences as a neonatal nurse working to support parents.

My hope is that this project emphasises the importance of services to support the specific needs of mothers with language barriers as they journey through maternal and neonatal care services.

Translation without a face

As a neonatal nurse, the impact of language barriers to non English-speaking families was something I observed frequently while caring for the tiniest members of our population on a busy London neonatal unit. The inability to ‘understand’ and ‘be understood’ during this emotionally distressing period increased parental anxiety, and from my view reduced parental empowerment.

This existing problem was intensified during the Covid-19 pandemic as visitor access to many wards was restricted in hopes of reducing the spread of the virus.

Language translators were also restricted from the wards and in their place, telephone translating services were introduced. A quick ring and a translator would be able to have a three-way conversation: mother, doctor and translator. This was translation without a face.

The inspiration for my perspectives project came from my own experiences as a neonatal nurse working to support parents.

Is voice alone enough?

In the rush of ward life I realised that we rarely used these services – stretched between four babies at a time or two acutely unwell infants over a 12 hour shift, Google Translate became our default. But what was the cost of prioritising convenience over the quality of translation support?

Communication is vital to delivering compassionate care but communication involves more than just our tone of voice, it involves our body language, facial expressions, eye contact.

This raises the question of how much gets lost in translation when a mother does not have the opportunity to communicate her needs freely with those providing her and her child with care.

A lack of data

When I completed my initial research on this topic, the current statistical information from the Office for National Statistics is available for ‘Live births, stillbirths and neonatal deaths’ by socio-economic classification, region and ethnicity but not by primary language spoken.

Additionally, most charities didn’t have any statistical evidence to highlight the prevalence of language barriers in neonatal and maternity settings.

Although studies have been completed by neonatal clinicians in America and Europe that explore the impact of language on their patient cohorts, at the time of my research there was a lack of evidence and studies to highlight the impact of language within these settings in the UK.

In 2010, NICE estimated that 10% of babies were born to non English-speaking mothers. And in 2020, the Office for National Statistics reported that 29.3% of births were to women born outside the UK; this is the highest since records began in 1969, continuing the general long-term increase.

The current number of non English-speaking mothers receiving maternity and neonatal care is unknown. Without this information, it’s not possible to assess the impact of language in these settings and ensure every mother has the support they need to access services during their pregnancy and birth.

Capturing voices

As part of the project, I photographed two wonderful mothers, Nadifa and Lizeth who also shared their experience of childbirth in the UK with language barriers.

The idea of using photography as a communications tool where there are barriers in spoken language is one that really intrigued me. Often, when we can see and hear who we are talking to, we are able to connect more and empathise with their story as we put faces to the experiences and feelings to statistics.

Listening to their stories allowed me to reflect on all the mothers I came across during my time on the ward and the difference translation made to parental collaboration in care.

As you hear their stories my hope is that your view of the importance of translation services will also be challenged.

See their stories in their own words.