Fatima: language access, cultural safety and clinical risk
Setting: Maternity care: antenatal admission at 35 weeks of pregnancy.
Context
Fatima is expecting her second baby and is admitted to the ward via Triage at 35 weeks of pregnancy with abdominal pain. She speaks little English. Her husband speaks some English but is not fluent.
What happened
Over the next 24 hours, Fatima has repeated episodes of pain and becomes very distressed. The fetal heart rate is monitored using cardiotocography (CTG) twice a day. There is no vaginal blood loss documented.
Fetal movements are recorded as present, but the pattern is not described. Fatima spends long periods rocking on her bed and she frequently splashes water on her face. She eats little but indicates that she wants to be fed yoghurt.
Communication is conducted through her husband when he is present during visiting. The obstetric team reviews Fatima several times, but records do not indicate that an interpreter is used. Midwifery records describe Fatima’s behaviour and document staff concerns about water reaching electrical points.
They also record that staff declined to feed her. There is no evidence that an interpreter is used to explore Fatima’s pain, distress, wishes, religious practice or understanding of her care.
Impact
Fatima’s pain continues and then becomes severe and constant. She is taken to theatre, where a large concealed antepartum haemorrhage of 1750 ml is identified.
Sadly, Fatima’s baby was stillborn, and she required a blood transfusion.
The absence of effective communication meant that staff could not build a relationship with Fatima, understand what was happening to her, provide personalised care, or fully assess and respond to her concerns.
What anti-racist practice should look like
Language access is a safety intervention. Interpretation should be used proactively and documented clearly. Reliance on family members should not replace professional interpreting, particularly for assessment, consent, pain, risk, escalation or decision-making. Cultural and religious practices should be approached with curiosity and respect, not assumption.
Key learning points
- Professional interpreters should be used when care is being assessed, planned, delivered or changed
- Relatives should not be used as the main route for clinical communication
- Failure to provide interpretation can create unsafe and inequitable care
- Pain, distress and behavioural cues should be explored, not simply recorded as behaviour
- Religious practice should be recognised and understood as part of personalised care
- Staff should document interpreter use, communication barriers and actions taken to address them
- Multidisciplinary care should include shared understanding of the woman’s concerns, wishes and clinical risk
- Cultural safety requires respectful communication, curiosity and timely escalation when communication is inadequate.
Previous
