Interpreters and Communication Support in Labour

The recommendation, in full

NICE's intrapartum guideline sets out what should happen when a woman and her birth companions are given information about care during labour. Teams should:

• use clear, plain language and confirm with the woman that she has understood;
• tailor the content and delivery of information to her needs and preferences;
• ensure that she "is empowered to make a supported decision with her healthcare team", which may include "using reliable interpreting services when needed (for example, for languages other than English, British Sign Language, or Makaton)";
• use "interpreters who are independent of the woman (rather than, for example, a family member or friend)";
• use culturally sensitive language;
• adapt communication where necessary, "for example, by using healthcare passports for people with learning disabilities or autism".

NICE's antenatal guideline says the same thing for pregnancy: "Ensure that reliable interpreting services are available when needed, including British Sign Language. Interpreters should be independent of the woman rather than using a family member or friend."

Why "independent of the woman" matters

It reads like bureaucratic caution and it is not. A relative interpreting for you is being asked to translate questions about your body, your previous pregnancies, your relationships and your consent, in front of you, in a room where the answers may be things you would not say in front of them.

A family member may soften a question, answer on your behalf, omit an option they disapprove of, or simply not know the vocabulary. None of that is malice, and all of it means the decision recorded as yours may not be yours.

Consent depends on the information reaching you. Birthrights puts the general standard plainly: information "must not be misleading", must be up to date, and you must be able to ask questions and have them answered properly. It also states the practical obligation: "If you need an interpreter or support to communicate the Trust should provide this."

What to ask for, and when

Antenatally is the time. Interpreting for labour has to be arranged, and a request made at 3 cm is a request made too late.

Worth asking for and having written into your notes:

• The language and dialect you want, and whether you want a female interpreter.
• Whether the service is face-to-face, by telephone or by video, and which is planned for labour.
• That you do not want a family member used as an interpreter, if that is your preference — and that this is recorded so nobody has to ask you in front of them.
• British Sign Language provision for labour, including out of hours.
• Whether written information is available in your language.

The HSE's material on preparing for a positive birth experience makes the general point that applies here: the preferences most likely to be met are the ones discussed and written down in advance.

If you are deaf or hard of hearing

BSL is named in both NICE guidelines, which makes it a specific expectation rather than a general good intention. Ask how BSL interpreting is provided overnight and at weekends, because that is where services most often fall down.

Practical adjustments worth recording: that staff should face you when speaking, that masks may need to be lowered where it is safe to do so, that you want written notes for key decisions, and how you want to be alerted if something is happening behind you.

If you have a learning disability or are autistic

NICE names healthcare passports specifically. A passport is a short document you or someone supporting you writes, describing how you communicate, what distresses you, what helps, and what staff should do.

Things that commonly go into one for a birth: sensory needs around light, noise and touch; how you want to be told before anything touches you; whether you want a running commentary or silence; the words that mean stop; who should be with you; and what a meltdown or shutdown looks like for you so that it is not read as refusal or confusion.

Birthrights notes that reasonable adjustments for a disability should be recorded in your notes or birth plan, and that under the Equality Act 2010 a trust has to provide them. Its examples include room for a wheelchair, lighting that helps you see, "a quiet or dark room to help with sensory overwhelm", and time after the birth to recover from fatigue.

Adjustments are a duty, not a favour

This is the part worth holding onto if you are told something cannot be done. Birthrights: "If you need reasonable adjustments under the Equality Act 2010, the Trust has to provide these."

Its wider material on human rights in maternity care sets out the same principle at a higher level — that care should be personalised and delivered with dignity and respect, and that this applies to how you are communicated with as much as to what is done to you.

NICE's own expectations of staff include respecting personal space, privacy and dignity, asking what you want to be called, explaining every procedure before it happens, and involving you in handovers between professionals, "in the room, when appropriate, with the woman at the centre of the handover discussion". A handover conducted over your head in a language you do not follow is the specific thing that recommendation was written against.

If communication broke down

Consent given without understanding is a problem, not a technicality. The NHS's guidance on consent to treatment describes consent as needing to be informed as well as voluntary, and Birthrights is explicit that a signed form is evidence rather than proof — "other evidence may show you did not have enough information".

If you were not given an interpreter, or a relative was used against your wishes, or an adjustment you had agreed was not provided, that is something to raise. Your maternity records will show what was recorded, and you have a right to see them without giving a reason.

For birth partners

If you are the person who has always interpreted for someone, stepping back can feel like abandoning them. It is the opposite. Ask for a professional interpreter early, then do the job only you can do: knowing what she wanted, noticing when she is not being asked, and saying so.