“Ok Sia, push down into your bottom,” said the obstetrician.
I really, really wished I had insisted we find an interpreter. The problem is that communicating with anyone is hard just before they deliver a baby – women lose their first language never mind a partially-learnt second. Add a fear that your baby might die and translating becomes close to impossible.
It wasn’t an awful scenario on the baby front – he had taken a poo which is always a worry and his mother’s cervix had taken only half an hour to fully dilate so he was a little bit surprised by the rapid turn of events. By the looks of things he had good reserves and should deliver vaginally but listening to his heart rate slow down periodically was certainly shitting me up and probably not doing his mother the world of good. The energy in the room was not great – there was the doctor, her assistant, the labour ward co-ordinator and another midwife who was in to lend a hand – everyone was fussy and mildly panicking.
The couple were from a country in West Africa and their first language isn’t very widely spoken so it might not have been possible to get an interpreter in time. Though I didn’t even try as when I first met them I asked if they wanted an interpreter and they said no, they would be fine. Maybe they were being polite – as in “would you like an extra slice of cake?” – “no I’m fine.” Maybe they didn’t want a non-medical complete stranger, who might not even be female, watch the delivery of their baby. Whatever – we didn’t get an interpreter.
“I’m just going to examine you,” the doctor said about 5 nanoseconds before putting her hand into Sia’s vagina. Consent-wise not best practice. Fuck, I thought, I’ve got to be a better midwife than this.
“Mo”, I said turning to the husband. “Can you tell Sia that the doctor is just checking…”. I drifted off as he was not paying me the slightest bit of attention, was gripping his wife’s hand with extreme force and I think chanting something.
“I’m going to need to give you a small cut,” said the doctor, turning to find some scissors and seemingly throwing the whole consent thing out of the window.
“Sia, the doctor wants to make a small cut in your vagina, as we are worried about the baby’s heart rate but we can’t do anything unless you agree,” I said – far more for the doctor’s benefit than Sia’s. I should have been more assertive on her behalf but this was the best I could do.
“Is it ok if I cut you?” the doctor finally caught my drift. There was some discussion between husband and wife and something that was at least approaching informed consent was given.
Baby was fine within a few minutes of birth. His mother took a little longer. She seemed initially shell-shocked but after a while seemed to relax. When I transferred her to the postnatal ward she thanked me for her care. Which I’m aware I didn’t completely deserve.
Black women are five times more likely to die in childbirth than their white counterparts and we don’t know exactly why. Socioeconomics and just regular racism probably come into play but care can go to shit when language is a barrier.
Getting an interpreter is time-consuming; I might have forced the issue if there was another member of staff with time to arrange one so I didn’t have to fear missing the birth while I was on the phone. They are not always available and certainly not as quickly as you need with emergency admissions. Even with a good interpreter communication is not ideal and that’s when important things get missed.
We could maybe even things up by recognising that women with a language barrier need more resources, and support midwives caring for them. Educating women at risk antenatally to explain the importance of interpreting services – and how even being 80% fluent might not be enough when your perineum is stretched by about 800%. Whatever we do might not mitigate risks completely but it could make it a little fairer and kinder.