Translating informed consent in Scottish maternity services: perspectives from providers and researchers of both maternity care and translation/interpreting services.

Jenny Patterson , Şebnem Susam-Saraeva

Language and Health ›› 2024, Vol. 2 ›› Issue (2) : 10023

PDF (960KB)
Language and Health ›› 2024, Vol. 2 ›› Issue (2) :10023 DOI: 10.1016/j.laheal.2024.06.001
Research article
research-article
Translating informed consent in Scottish maternity services: perspectives from providers and researchers of both maternity care and translation/interpreting services.
Author information +
History +
PDF (960KB)

Abstract

Background: Failing to meet the communication and information needs of childbearing women leaves them unable to provide true informed consent. Lack of control or lack of involvement in decision making contribute to birth trauma. For those with Limited English Proficiency (LEP) receiving information requires use of interpreters often hindered within pressurised maternity services and urgent situations. Women with LEP are often of ethnicities at risk of poorer maternity outcomes and from cultures where maternity service practices differ from Scottish maternity services. Question: How do maternity care professionals (MCPs) and translation & interpreting (T & I) providers experience their role around informed consent when caring for women with LEP in Scotland; what do they identify as barriers or facilitators? Methods: Data were collected using qualitative methodology through online focus groups and interactive workshops including a mix of MCPs and T & I providers. Recruitment used a snowball approach via word of mouth and email. Focus groups were audio recorded and transcribed verbatim, workshops were audio-visually recorded and closely examined. Data were analysed using Framework analysis. Results: Four themes emerged from the study: 1) Limited resources; 2) Inter-professional concerns; 3) Cultural heritage; and 4) Power. Discussion: Limited resources affect women, MCPs and interpreting services. A lack of cultural awareness and power differentials create pressure for everyone within the process. Conclusion: LEP increases complexity around informed consent. Challenges are multifaceted compounded by lack of time and resources alongside power differentials. Trust, respect and continuity are key facilitators.

Keywords

Midwifery / Informed consent / Interpreting / Cultural awareness / Midwifery education

Cite this article

Download citation ▾
Jenny Patterson, Şebnem Susam-Saraeva. Translating informed consent in Scottish maternity services: perspectives from providers and researchers of both maternity care and translation/interpreting services.. Language and Health, 2024, 2(2): 10023 DOI:10.1016/j.laheal.2024.06.001

登录浏览全文

4963

注册一个新账户 忘记密码

Funding

The project was funded by the Royal Society of Edinburgh Research Workshop Grant (Ref. No. 1711).

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Data availability

The authors do not have permission to share data.

Acknowledgements

We thank all the participants for taking the time to participate in this study and for their willingness to share with each other regarding their experiences We also wish to thank the Royal society of Edinburgh for funding this study and Active Inquiry for their valuable interactive workshops.

References

[1]

Active Inquiry. (2023a). Welcome. https://www.activeinquiry.co.uk.

[2]

Active Inquiry. (2023b). A few questions answered. http://www.activeinquiry.co.uk/questions.php.

[3]

Alcorn K. L., O ’ Donovan A., Patrick J. C., Creedy D., & Devilly G. J. (2010). A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events. Psychological Medicine, 40 (11), 1849-1859. https://doi.org/10.1017/S0033291709992224

[4]

Birthrights. (2020 July). Human rights implications of changes to maternity services during the Covid-19 pandemic Birthrights briefing. 〈https://www.birthrights.org.uk/wp-content/uploads/2020/07/Birthrights-Covid-19-Human-Rights-Committee-Briefing-July-2020.pdf〉.

[5]

Birthrights. (2022). Systemic racism, not broken bodies. An inquiry into racial injustice and human rights in UK maternity care. 〈https://www.birthrights.org.uk/campaigns-research/racial-injustice/〉.

[6]

Buckley S. J. (2015). Executive Summary of Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. The Journal of Perinatal Education, 24 (3), 145-153. https://doi.org/10.1891/1058-1243.24.3.145

[7]

Cave E. (2019). Informed Consent in Healthcare Settings. 〈https://digitalpublications.parliament.scot/ResearchBriefings/Report/2019/1/10/Informed-Consent-in-Healthcare-Settings〉.

[8]

Cook A. M. (2016). Midwifery perspectives: The consent process in the context of patient safety and medico-legal issues. Clinical Risk, 22 (1/2), 25-29. 〈 https://doi-org.ezproxy.napier.ac.uk/10.1177/1356262216672614 〉〈https://doi-org.ezproxy.napier.ac.uk/10.1177/1356262216672614〉.

[9]

Care Quality Commission. (2022). Safety, equity and engagement in maternity services. 〈https://www.cqc.org.uk/publications/themes-care/safety-equity-engagement-maternity-services〉.

[10]

Cull J., Brooks E., Anwar N., Cunningham J., Forman J., & Hall D. (2022). Why are some voices not heard? Exploring how maternity care can be improved for women with limited English. MIDIRS Midwifery Digest, 32 (2), 142-146. 〈https://www.midirs.org/latest-news/blog/2022/midirs-midwifery-digest-hot-topic-why-are-some-voices-not-heard-exploring-how-maternity-care-can-be-improved-for-women-with-limited-english/〉.

[11]

Department of Health and Social Care. (2009). Reference guide to consent for examination or treatment (second edition). Guide to the legal framework that health professionals need to take account of in obtaining valid consent to examination, treatment or care. 〈https://www.gov.uk/government/publications/reference-guide-to-consent-for-examination-or-treatment-second-edition〉.

[12]

Department of Health and Social Care. (2022). Ockenden review: summary of findings, conclusions and essential actions. 〈https://www.gov.uk/government/publications/final-report-of-the-ockenden-review/ockenden-review-summary-of-findings-conclusions-and-essential-actions〉.

[13]

Dharni N., Essex H., Bryant M. J., Cronin de Chavez A., Willan K., Farrar D., Bywater T., Dickerson J., & Better Start Bradford Innovation Hub. (2021). The key components of a successful model of midwifery-led continuity of carer, without continuity at birth: Findings from a qualitative implementation evaluation. BMC Pregnancy and Childbirth, 21 (1), 205. https://doi.org/10.1186/s12884-021-03671-2

[14]

Doetsch J., Almendra R., Carrapatoso M., Teixeira C., & Barros H. (2021). Equitable migrant-friendly perinatal healthcare access and quality in public maternity units in Portugal. European Journal of Public Health, 31 (5), 951-957. 〈 https://doi-org.ezproxy.napier.ac.uk/10.1093/eurpub/ckab125 〉〈https://doi-org.ezproxy.napier.ac.uk/10.1093/eurpub/ckab125〉.

[15]

Esegbona-Adeigbe S. (2018). Cultural qualities and antenatal care for black African women: A literature review. British Journal of Midwifery, 26 (8). 〈https://www.britishjournalofmidwifery.com/content/literature-review/cultural-qualities-and-antenatal-care-for-black-african-women-a-literature-review/〉.

[16]

Furber C. (2010). Framework analysis: a method for analysing qualitative data. African Journal of Midwifery and Women’s Health, 4 (2), 97-100. https://doi.org/10.12968/ajmw.2010.4.2.47612

[17]

Gale N. K., Heath G., Cameron E., Rashid S., & Redwood S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13, 117. https://doi.org/10.1186/1471-2288-13-117

[18]

General Medical Council. (2020). Decision making and consent. 〈https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/decision-making-and-consent〉.

[19]

Golden P. (2018). Coercion or consent? British Journal of Midwifery, 26 (7), 482-883. https://doi.org/10.12968/bjom.2018.26.7.482

[20]

Griggs B. (2019). Antenatal Education Evidence review. Public health Suffolk,. https://www.nice.org.uk/Media/Default/sharedlearning/FileUpload1_Antenatal%20Education%20Evidence%20Review%20Final.docx#:%E2%88%BC:text=There%20continues%20to%20be%20variation,take%20up%20antenatal%20education%20classes.

[21]

Harris J., Beck S., Ayers N., Bick D., Lamb B. W., Aref-Adib M., Kelly T., Green J. S. A., & Taylor C. (2022). Improving teamwork in maternity services: A rapid review of interventions. Midwifery, 108, Article 103285. https://doi.org/10.1016/j.midw.2022.103285

[22]

Hishikawa K., Kusaka T., Fukuda T., Kohata Y., & Inoue H. (2019). Anxiety or nervousness disturbs the progress of birth based on human behavioral evolutionary biology. The Journal of Perinatal Education, 28 (4), 218-223. https://doi.org/10.1891/1058-1243.28.4.218

[23]

Hlavac J., & Harrison C. (2021). Interpreter-mediated doctor-patient interactions: interprofessional education in the training of future interpreters and doctors. Perspectives, 29 (4), 572-590. https://doi.org/10.1080/0907676X.2021.1873397

[24]

Jardine J., Walker K., Gurol-Urganci I., Webster K., Muller P., Hawdon J., Khalil A., Harris T., van der Meulen J., & National Maternity and Perinatal Audit Project Team. (2021). Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: A national cohort study. The Lancet, 398 (10314), 1905-1912. https://doi.org/10.1016/S0140-6736(21)01595-6

[25]

Jones E., Lattof S. R., & Coast E. (2017). Interventions to provide culturally-appropriate maternity care services: Factors affecting implementation. BMC Pregnancy and Childbirth, 17 (1), 267. https://doi.org/10.1186/s12884-017-1449-7

[26]

Khan Z. (2021). Ethnic health inequalities in the UK ’ s maternity services: A systematic literature review. The British Journal of Midwifery, 29 (2). https://doi.org/10.12968/bjom.2021.29.2.100

[27]

Kilfoyle K. A., Vitko M., O ’ Conor R., & Bailey S. C. (2016). Health literacy and women ’ s reproductive health: A systematic review. Journal of Women’s Health, 25 (12), 1237-1255. https://doi.org/10.1089/jwh.2016.5810

[28]

Kingma E. (2021). Harming one to benefit another: The paradox of autonomy and consent in maternity care. Bioethics, 35 (5), 456-464. 〈 https://doi-org.ezproxy.napier.ac.uk/10.1111/bioe.12852 〉https://doi-org.ezproxy.napier.ac.uk/10.1111/bioe.12852〉.

[29]

Kloester J., Willey S., Hall H., & Brand G. (2022). Midwives ’ experiences of facilitating informed decision-making-A narrative literature review. Midwifery, 109, Article 103322. https://doi.org/10.1016/j.midw.2022.103322

[30]

Knapp R. (2017). Wellbeing and Resilience: 4. Time Management. The Practising Midwife, 20 (9)). 〈https://www.all4maternity.com/wellbeing-resilience-4-time-management/〉.

[31]

{C}Knight M., Bunch K., Felker A., Patel R., Kotnis R., Kenyon S., & Kurinczuk, J.J. (Eds{C}.) (2023). Saving Lives, Improving Mothers’ Care: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2019-21. 〈https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2023/MBRRACE-UK_Maternal_Compiled_Report_2023.pdf〉.

[32]

Larkin M., Shaw R., & Flowers P. (2018). Multi-perspectival designs and processes in interpretative phenomenological analysis research. Qualitative Research in Psychology, 16 (2), 182-198. https://doi.org/10.1080/14780887.2018.1540655

[33]

Le Neveu M., Berger Z., & Gross M. (2020). Lost in translation: The role of interpreters on labor and delivery. Health Equity, 4 (1), 406-409. https://doi.org/10.1089/heq.2020.0016

[34]

Lee N., Kearney L., Shipton E., Hawley G., Winters-Chang P., Kilgour C., Brady S., Peacock A., Anderson L., & Humphrey T. (2023). Consent during labour and birth as observed by midwifery students: A mixed methods study. Women and Birth, 36 (6), e 574-e581. https://doi.org/10.1016/j.wombi.2023.02.005

[35]

Liberati E. G., Tarrant C., Willars J., Draycott T., Winter C., Kuberska K., Paton A., Marjanovic S., Leach B., Lichten C., Hocking L., Ball S., Dixon-Woods M., & SCALING Authorship Group. (2021). Seven features of safety in maternity units: A framework based on multisite ethnography and stakeholder consultation. BMJ Quality & Safety, 30 (6), 444-456. https://doi.org/10.1136/bmjqs-2020-010988

[36]

Madeley A. (2023). Exploring informed consent in midwifery care. British Journal of Midwifery, 31 (6). 〈https://www.britishjournalofmidwifery.com/content/professional/exploring-informed-consent-in-midwifery-care〉.

[37]

Malterud K., Siersma V. D., & Guassora A. D. (2016). Sample size in qualitative interview studies: Guided by information power. Qualitative Health Research, 26 (13), 1753-1760. https://doi.org/10.1177/1049732315617444

[38]

Marsh A. (2019). The importance of language in maternity services. British Journal of Midwifery, 27 (5). 〈https://www.britishjournalofmidwifery.com/content/professional/the-importance-of-language-in-maternity-services/〉.

[39]

Mays N., & Pope C. (2000). Qualitative research in health care. Assessing quality in qualitative research. BMJ (Clinical Research Ed. ), 320 (7226), 50-52. https://doi.org/10.1136/bmj.320.7226.50

[40]

McInnes R. J., Aitken-Arbuckle A., Lake S., Hollins Martin C., & MacArthur J. (2020). Implementing continuity of midwife carer-Just a friendly face? A realist evaluation. BMC Health Services Research, 20 (1), 304. https://doi.org/10.1186/s12913-020-05159-9

[41]

National Health Service. (2018). Your first midwife appointment. 〈https://www.nhs.uk/pregnancy/finding-out/your-first-midwife-appointment/〉.

[42]

National Health Service. (2021). Newborn blood spot test. 〈https://www.nhs.uk/conditions/baby/newborn-screening/blood-spot-test/〉.

[43]

National Health Service. (8 dec 2022). Consent to treatment. 〈https://www.nhs.uk/conditions/consent-to-treatment/〉.

[44]

National Health Service Education for Scotland. (2017). Transforming Psychological Trauma: A knowledge and skills framework for the Scottish workforce. 〈https://transformingpsychologicaltrauma.scot/media/x54hw43l/nationaltraumatrainingframework.pdf〉.

[45]

National Health Service England. (2016). National Maternity Review: Better Births: Improving outcomes for maternity service in England. A five year forward view for maternity care. 〈https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf〉.

[46]

Nursing andMidwifery Council. (2018). The code Professional standards of practice and behaviour for nurses, midwives, and nursing associates. 〈https://www.nmc.org.uk/standards/code/〉.

[47]

Nursing andMidwifery Council. (2020). Continuity of care and carer. 〈https://www.nmc.org.uk/standards/standards-for-midwives/standards-of-proficiency-for-midwives/implementation-midwifery/midwifery/continuity-care-carer/〉.

[48]

The National Institute for Health and Care Excellence. (2021). Antenatal Guidelines [NG201]. 〈https://www.nice.org.uk/guidance/ng201〉.

[49]

Olza I., Leahy-Warren P., Benyamini Y., Kazmierczak M., Karlsdottir S. I., Spyridou A., Crespo-Mirasol E., Takács L., Hall P. J., Murphy M., Jonsdottir S. S., Downe S., & Nieuwenhuijze M. J. (2018). Women ’ s psychological experiences of physiological childbirth: A meta-synthesis. BMJ Open, 8 (10), Article e020347. https://doi.org/10.1136/bmjopen-2017-020347

[50]

One in Four. (2023). 〈https://oneinfour.org.uk/about-one-in-four/〉.

[51]

Patterson J., Hollins Martin C. J., & Karatzias T. (2019). Disempowered midwives and traumatised women: Exploring the parallel processes of care provider interaction that contribute to women developing Post Traumatic Stress Disorder (PTSD) post childbirth. Midwifery, 76, 21-35. https://doi.org/10.1016/j.midw.2019.05.010

[52]

Patterson J., & Ménage D. (2020). Compassion as a Powerful Intervention: How the interactions between women, midwives and maternity services influence women ’ s childbirth experiences and subsequent trauma. The Practising Midwife, 23 (8). https://doi.org/10.55975/IAOD9019

[53]

Public Heath Scotland. (2022). Ready Steady Baby translations. 〈https://www.healthscotland.com/documents/31227.aspx〉.

[54]

Quality Improvement Scotland. (2008). Maternal History Taking Best Practice statement. National Health Service. 〈https://www.healthcareimprovementscotland.org/idoc.ashx?docid=6ae3f73e-4c6b-4dbe-abbb-1f625c9325ec&version=-1〉.

[55]

Raleigh V. S., Hussey D., Seccombe I., & Hallt K. (2010). Ethnic and social inequalities in women ’ s experience of maternity care in England: Results of a national survey. Journal of the Royal Society of Medicine, 103 (5), 188-198. https://doi.org/10.1258/jrsm.2010.090460

[56]

Reed R., Sharman R., & Inglis C. (2017). Women ’ s descriptions of childbirth trauma relating to care provider actions and interactions. BMC Pregnancy and Childbirth, 17, 21. https://doi.org/10.1186/s12884-016-1197-0

[57]

Royal College of Midwives. (2018). Position statement Midwifery continuity of Carer (McoC). 〈https://www.rcm.org.uk/media/5524/rcm-position-statement-midwifery-continuity-of-carer-mcoc.pdf〉.

[58]

Royal College of Midwives. (2023). Midwifery Continuity of Carer (MCoC). 〈https://www.rcm.org.uk/promoting/professional-practice/continuity-of-carer〉.

[59]

Robinson O. C. (2023). Probing in qualitative research interviews: Theory and practice. Qualitative Research in Psychology, 20 (3), 382-387. https://doi.org/10.1080/14780887.2023.2238625

[60]

Scottish Government. (2017). The best start: maternity and neonatal care plan executive summary. 〈https://www.gov.scot/publications/best-start-five-year-forward-plan-maternity-neonatal-care-scotland-9781786527646/〉.

[61]

Sellevold V. L., Hamre L. L., & Bondas T. E. (2022). A meta-ethnography of language challenges in midwifery care. European Journal of Midwifery, 6, 41. https://doi.org/10.18332/ejm/147994

[62]

Shorey S., Ng E. D., & Downe S. (2021). Cultural competence and experiences of maternity health care providers on care for migrant women: A qualitative meta-synthesis. Birth, 48, 458-469. https://doi.org/10.1111/birt.12581

[63]

Sonola L. (2012). Why continuity of care is crucial for patients. 〈https://www.kingsfund.org.uk/blog/2012/03/why-continuity-care-crucial-patients〉.

[64]

Sperlich M., Seng J. S., Li Y., Taylor J., & Bradbury-Jones C. (2017). Integrating trauma-informed care into maternity care practice: Conceptual and practical issues. Journal of Midwifery & Women’s Health, 62 (6), 661-672. https://doi.org/10.1111/jmwh.12674

[65]

Sun X., Fan X., Cong S., Wang R., Sha L., Xie H., Han J., Zhu Z., & Zhang A. (2023). Psychological birth trauma: A concept analysis. Frontiers in Psychology, 13, Article 1065612. https://doi.org/10.3389/fpsyg.2022.1065612

[66]

Susam-Saraeva, Ş., & Carvalho Fonseca L. (2021). Translation in maternal and neonatal health. In Ş. Susam-Saraeva, & New York:Eds.), Routledge Handbook of Translation and Health (pp. 348-368). London & Routledge.

[67]

Susam-Saraeva Ş. & Patterson J. forthcoming “ Sign and move on ” : interpreter awareness of legal and ethical informed consent in maternity care. Target : International Journal of Translation Studies.

[68]

Symon A. (2019). Obtaining and confirming consent. British Journal of Midwifery, 27 (12), 798-799. https://doi.org/10.12968/bjom.2019.27.12.798

[69]

Tarrant C., Dixon-Woods M., Colman A. M., & Stokes T. (2010). Continuity and trust in primary care: A qualitative study informed by game theory. Annals of Family Medicine, 8 (5), 440-446. https://doi.org/10.1370/afm.1160

[70]

Walsh S., Simmons-Jones F., & Best R. (2020). Care during covid-19:Partner attendance at maternity services. BMJ (Clinical Research Ed. ), 371, m3973. 〈https://doi-org.ezproxy.napier.ac.uk/10.1136/bmj.m3973〉.

[71]

Walton G. (2022). Midwifery Continuity of Carer-the clashing of truths. 〈https://www.rcm.org.uk/news-views/rcm-opinion/2022/midwifery-continuity-of-carer-the-clashing-of-truths/〉.

[72]

World Health Organisation. (2021). WHO recommendation on effective communication between maternity care providers and women in labour, 29th august 〈https://srhr.org/rhl/article/who-recommendation-on-effective-communication-between-maternity-care-providers-and-women-in-labour〉.

[73]

Yildiz P. D., Ayers S., & Phillips L. (2017). The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. Journal of Affective Disorders, 208, 634-645. https://doi.org/10.1016/j.jad.2016.10.009

PDF (960KB)

0

Accesses

0

Citation

Detail

Sections
Recommended

/