An Evaluation of Intrapartum Language Interpreter Provision and birth outcomes at a UK maternity hospital

An Evaluation of Intrapartum Language Interpreter Provision and birth outcomes at a UK maternity hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article An Evaluation of Intrapartum Language Interpreter Provision and birth outcomes at a UK maternity hospital Rachel Fucella, Lauren Philp-von Woyna This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8288697/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Background Women who have difficulty understanding or speaking English receive poorer care with higher morbidity and mortality rates, emphasizing the need for interpreter services to be accessible throughout labour and delivery. In addition, addressing language barriers through interpreter provision may improve women’s experiences of labour and birth, as well as birth outcomes. Aim The aim of this study was to examine the extent in which interpretation services were accessed for women requiring the provision during intrapartum care and its relationship with outcomes defined as, mode of birth, and length of labour. Methods A service evaluation methodology Findings 223 hospital intrapartum records were reviewed over a two-week study period at one maternity hospital. 48 (22%) women met the study inclusion criteria of whom 11 (23%) received intrapartum interpreter provision. Results indicate that mode of birth was not impacted by interpreter use (p= .262), but that length of labour may be impacted by interpreter use. Length of labour for women with ‘no interpreter’ had a longer mean length of labour (M= 157.06, SD 114.27) vs the ‘interpreter’ group (M= 65.25, SD 48.12) with greater variance in length of labour (381 vs 102 minutes) respectively. Despite this, results were found to be non-significant (p= .09). Conclusion Length of labour may be influenced by effective continuous support during labour and birth, including effective communication that addresses any language barriers. This study suggests that interpreter provision may aid labour progression, although further research is required with larger sample sizes. interpreting services language intrapartum labour and birth midwife evaluation Figures Figure 1 Problem or Issue and What is Already Known Addressing language barriers through interpreter provision may improve women’s experiences of labour and birth as well as birth outcomes. Language barriers in healthcare have been identified as leading to lower levels of service user satisfaction and safety, as well as higher rates of adverse outcomes (Suphanchaimat et al., 2015; Kwan et al., 2023). The critical need for professional language interpretation services during intrapartum care is well-documented (Origlia Ikhilor et al., 2019; Le Neveu et al., 2020; Sentell et al., 2016). In the UK, a recent confidential enquiry into maternal deaths highlighted that non-English speaking women receive poorer care, with higher morbidity and mortality rates, emphasizing the need for interpreter services to be accessible throughout labour and delivery (Knight et al, 2022b). Despite the UK’s National Institute for Health and Care Excellence (NICE) guidelines mandating that provision or offer of interpreter services for women who have difficulty understanding or speaking English is essential, findings in this evaluation indicated that only 23% of women received these services during their intrapartum care when it was required. What this Paper Adds This paper highlights a measurable difference between interpreter use and length of labour which has not previously been identified in current literature. Length of labour for women with ‘no interpreter’ experienced a longer mean length of labour (M= 157.06, SD 114.27) when compared to the ‘interpreter’ group (M= 65.25, SD 48.12) with greater variance in length of labour (381 vs 102 minutes), respectively. Despite this, results were found to be non-significant (p= .09), and no differences were found in mode of birth. The paper highlights the need for further evaluative projects or studies with larger samples to better examine language barriers, access to interpreter provision and labour and birth outcomes. Background Problem description Childbirth. For many it is a time of great joy, but for some it is a time of significant vulnerability. The role of the midwife, as the Old English root of the title suggests, is to be alongside women through pregnancy, childbirth and beyond (Reed, 2021 ). At the heart of this ‘being with’ is the development of therapeutic relationship built on trust, with the bedrock of this trust being clear and open communication (Bradfield et al., 2020 ; Kuliukas et al., 2020 ). Language barriers obstruct channels of communication between a woman and her midwife and impact a woman’s experience of labour and birth which may in turn be associated with longer length of labour and mode of birth (Chioma et al., 2024). This evaluation aimed to understand the extent to which interpretation services were accessed for women during intrapartum care and examined the relationship between the provision of interpretation services, mode of birth, and length of labour. Available knowledge The vulnerability of women in the perinatal period is a complex and multifaceted issue, but the specific problem of language barriers has been identified, both in academic literature and public policy (Knight et al., 2022b ; Viveiros and Darling, 2019; Bains et al., 2021a ; Filby et al., 2016 ; NICE, 2021 ). A Public Health England (PHE) report noted that women from minority ethnic communities, accessing healthcare in the Midlands, UK were less likely to confidently use English when compared to men in their communities suggesting language interpretation provision needs are higher in women’s health and maternity (Blennerhassett, 2020 ). Internationally, Scandinavian studies have explored the experiences of midwives caring for women who do not speak the lingua franca (Abdulle et al., 2023 ; Akselsson et al., 2022 ; Bains et al., 2021b , 2021a ). These studies highlight challenges of being ‘with woman’, the core of the midwife’s role, when linguistic barriers are present. These reflections were echoed by UK based study by Bridle et al(2021) where one participant described the pain of being unable to support a woman ‘through the most difficult experience of her life, because we couldn’t talk to her’ (Bridle et al., 2021 , p.367). In addition, concerns were raised about inability to formally or thoroughly consent women during emergency procedures, including a case where health professionals explained they ‘couldn’t consent her for [caesarean] section – we just had to do it’ (Bridle et al., 2021 , p.367). Project20 (Rayment-Jones et al., 2021b , 2021a ) included longitudinal, qualitative studies that explored the views of non-English speaking women accessing two inner-city maternity services in the UK by undertaking interviews. Data was analysed using a thematic framework that identified barriers to accessing services associated with language needs, lack of choice, and concerns about confidentiality when interpreting services were used. Navodani et al. ( 2019 ) also found that poor provision of interpreting services means women are unable to disclose risk factors or communicate concerns (Rayment-Jones et al., 2021b ). Rationale Globally, language barriers in healthcare have been linked, through systematic literature reviews to lower levels of service user satisfaction and safety, as well as higher rates of adverse outcomes (Suphanchaimat et al., 2015; Kwan et al., 2023 ). Focusing in on maternity services, the critical need for professional interpreting services, during the intrapartum period, has been clearly highlighted and explored across a range of geographic and linguistic contexts (Origlia Ikhilor et al., 2019 ; Le Neveu et al., 2020 ; Sentell et al., 2016 ). The Mothers and Babies: Reducing Risk through Audits and Confidential Enquires across the UK (MBRRACE) report clearly states that women who do not speak English receive poorer care, demonstrated by higher rates of morbidity and mortality (Knight et al., 2022b , 2022a ). The report includes a critical recommendation – that every birthing person who requires it should have access to an interpreting service throughout the course of their labour and delivery (Knight et al., 2022b ). 1 in 5 maternal deaths reported by MBRRACE in 2018–2020 were women who were identified as speaking little to no English (Knight et al., 2022a ). Key issues identified were delays in care and missed risk factors and red flag signs which, if identified, may have significantly altered outcomes. Interpreting provision enables timely reporting of risk factors and red flag signs by women. Despite this, MacLellen et al. (2024) found a significant variance in the demand for, spending on, and provision of interpreting services across 100 healthcare facilities in the UK suggesting this area requires evaluation and research. Aim This service evaluation aimed to understand the extent in which interpreting services were accessed for women during intrapartum care at a Midlands maternity hospital and, examined the relationship between the provision of interpreting services, mode of birth, and length of labour. Methodology Context This evaluation was conducted at a Maternity Unit in the Midlands, UK. The hospital is situated near a linguistically and culturally diverse population with recent Census data indicating that up to 30% of the local population speak ‘little to no English’ (Waddington, 2022). Therefore, within the specific context, use of language interpreting services for the large proportion of local women who require it during intrapartum care can indicate whether women are receiving high quality care which meets their needs (Jenkinson, 2023 ; Filby et al., 2016 ). There are acknowledged inconsistencies in the use of interpreting services and availability of information in different languages (Jenkinson, 2023 ), but the direct and local impact on intrapartum outcomes is unknown. Locally, concerns have been raised about whether care is person-centred and holistic (CQC, 2024) and the Birmingham and Solihull Intragrated Care System (2024) highlighted the local critical and pressing challenges of providing care for a diverse population. Approach & Measures The Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) framework (reference) was used to report the evaluation. All women who attended the maternity unit for intrapartum care from 19th February 2024- 3rd March 2024 were included in the evaluation. This period was selected to provide a succinct but not insignificant dataset which can be examined to inform improvements (Beake et al, 1997). Women were divided into groups as ‘requiring’ or ‘not requiring’ language interpretation services from details recorded in the maternal electronic records. Women were identified as ‘requiring’ interpretation services if a health professional had selected either ‘Non-English speaking’ or ‘Can’t speak or understand English’ during the early pregnancy booking appointment. This allowed for the most pertinent and relevant data to be collected (Campbell et al., 2020 ). Quantitative, measurable outcomes collected data from maternal electronic records about whether interpreter use was documented during labour and type of service accessed (whether telephone, in person or video link), the length of labour in minutes and the mode of birth as vaginal, instrumental or caesarean birth. This was inclusive of planned caesarean births. Intervention The SQUIRE guidelines are intended for reporting local interventions and their associated outcomes during the provision of care or practice that can improve the quality safety and value of healthcare (SQUIRE, 2022). In this evaluation, the intervention was defined as use of a language interpreter. The impact of receiving or not receiving a language interpreter where it was required was evaluated through measurable outcomes by extracting data from maternal notes about mode of birth and length of labour. Ethics Local permission was obtained, and the evaluation was registered with the local Clinical Audit Registration & Management System (CARMS) and Clinical Governance team. The evaluation does not meet the threshold stipulated by the UK’s Medical Research Council and Health Research Authority (2022) for a formal ethics review. Data was collected in a private office by the primary author who complied with UK General Data Protection Regulation (2016) and all data was appropriately anonymised and stored on a secure, password-protected device shared only with the authors. Data was deleted following analysis. Data Analysis Data collected was analysed using descriptive and inferential statistics. Descriptive elements were presented in readable charts to highlight key trends. Further analysis using Chi-squared and Kruskall-Wallis determined if outcomes associated with interpreter use were statistically significant. Results 223 women attended the hospital for intrapartum care during the evaluative period. 48 (22%) of women met the defined threshold for requiring an interpreter for intrapartum care. Table 1. Summarises the primary language requirements of the sample. Table 1: Primary Non-English Language Spoken Urdu 18 Bengali 6 Pashto 5 Somali 4 Arabic 4 Language not recorded 3 Romanian 3 Dari 2 Bulgarian 1 Sylheti 1 Tigrinya 1 Despite 48 (22%) of women requiring an interpreter, only 11 (23%) of the women received an interpreter during intrapartum care meaning 37 (77%) of women who required an interpreter did not receive care that included interpreting services. In one of the 37 cases where an interpreter was identified as required, a family member was recorded as the interpreter. Interpreter use and mode of birth The sample results were divided into datasets of either ‘Interpreter’ (interpreter needed and used) or ‘no interpreter’ (interpreter required but not used). Data from each group was analysed to evaluate impact on measurable outcomes as, mode of birth and length of labour (in cases where labour occurred, n = 20). Table 2 . summarises 48 intrapartum cases grouped as ‘interpreter’ and ‘no interpreter’ and their mode of birth. Mode of birth is grouped into four categories, vaginal, Elective caesarean, emergency caesarean and instrumental birth. No interpreters were used for any elective caesarean births or any instrumental births in the evaluation. Among the birth outcomes, the ‘no interpreter’ group were more likely to experience both emergency caesarean birth, 8 (16%) vs 5 (10%) and vaginal birth 18 (38%) vs 3 (6%). Chi-Squared test was undertaken to analyse whether interpreter use was associated with mode of birth. Results were non-significant (X2 (1, n = 48) = 2.674, P = .262). The results indicated that interpreter use had no significant effect on mode of birth suggesting that interpreter use may not influence this outcome. Table 2 Interpreter provision & mode of birth No interpreter group Interpreter group Total number of births Elective caesarean birth 12 0 12 Emergency caesarean birth 8 5 13 Vaginal birth 18 3 21 Instrumental birth 2 0 2 Total number of births 40 8 48 Interpreter use and length of labour Twenty women were identified as requiring an interpreter and experienced labour. These women were divided into ‘interpreter’ or ‘no interpreter’ groups for evaluation of length of labour in minutes as a measurable outcome. Results found that women who did not have an interpreter experienced greater variance in their labour length (range, 17–398, Mean = 157.06, SD 114.27) when compared to women who had an interpreter (range 35–137, Mean = 65.25, SD 48.12). Labour length differences between the groups is illustrated in Diagram 1 and Table 3 . These results suggest that labour is likely to be both longer and the length more varied when an interpreter is identified as needed but not used. Table 3 Descriptive statistics: length of labour No interpreter group Interpreter group Mean 157.0625 65.25 Median 138 44.5 SD 114.270713 48.127435 Range 381 102 Minimum 17 35 Maximum 398 137 Total count 16 4 Kruskall-Wallis test was undertaken to determine if length of labour was significantly longer with ‘no interpreter’ compared to the ‘interpreter’ group. The result is not significant (H statistic is 2.7273 (1, N = 20), p = 0.09865 at p < .05). A larger sample is required to evaluate a possible significant association between interpreter use and length of labour. Discussion Summary Findings indicate that when an interpreter was required during intrapartum care 77% of women did not receive an interpreter. In this evaluation, when an interpreter was required but not provided, it did not appear to impact the mode of birth, however, the sample size limits findings and further research is required. The evaluation found that not receiving interpretation services when required may contribute towards a longer labour length with Mean length of labour increasing without an interpreter, although this result was found to be non-significant. Results also suggest there is greater variance when an interpreter is not used which may suggest that the use of an interpreter influences individuals differently or other confounding variables need to be included in further research. Further evaluative projects or studies which examine this issue is needed. Over the course of the study period, 223 women attended the study site to receive intrapartum care and 48 (22%) of these were identified during the intrapartum risk assessment as requiring an interpreter. These women spoke a diverse range of languages, as illustrated in Table 1. Despite the identification of the need for interpreters, and its classification as an intrapartum risk factor, only 11 (23%) have any documented record of interpreter provision. As stated in the contextual background it must be noted that, although discouraged, the use informal interpreters in the form of friends or family members can be requested. One case was found of a family member being used as an interpreter in the evaluative sample. Akinwotu ( 2020 ) suggests using family members as interpreters presents ethical concerns surrounding confidentiality and veracity. Mode of birth Interpreter provision did not significantly influence mode of birth, however, data highlighted some concerning features about care provided to non-English speaking women during labour and birth. Twelve women who identified as speaking little to no English underwent elective caesarean births. None of these had interpreter provision at any point during their intrapartum care, including upon admission to hospital, on the day of the procedure through to the commencement of postnatal care. This is despite the planned procedures allowing time for organisation of interpreting services prior to admission. Molina et al. ( 2022 ) supports that where an interpreter is required and not used, informed consent cannot be legitimately claimed raising ethical concerns about the consent and care provided to the twelve women who underwent elective caesarean births. Further examination reveals slightly improved rate of interpreter provision for women who underwent emergency caesarean births during the study period with 5 out of 13 women who had an emergency caesarean having an interpreter. Documentation revealed that during emergency situations, and specifically when the decision to proceed with a caesarean was made, the provision of an interpreter was prioritised. Records show specification regarding the form of interpreting service, most frequently telephone, alongside what information was communicated. In two cases, it was noted that multilingual staff communicated directly with women and their families. Although this is not provision of interpreter through a formal service, it provided insight about how staff overcame communication challenges in practice. Length of labour Length of labour was more variable and longer when no interpreter was used. Length of labour is thought to be influenced by effective continuous support during labour and birth which includes effective communication (Bohren et al., 2017). A Cochrane review by Bohren et al. (2017) found that where women receive continuous support, they are more likely to have a vaginal birth (RR 1.08, 95% CI 1.04–1.12; 21 trials, 14,369 women) and their labours were shorter (MD -0.69 hours, 95% CI ‐1.04 to ‐0.34; 13 trials, 5429 women). Despite Bohren et al’s (2017) review including some lower quality evidence, the findings were supported by large samples and wider evidence. There is strong and longstanding evidence suggesting that psychological anxiety during labour and birth can lengthen labour through the release of stress hormones, such as cortisol (Morris and Haddad, 1989 ). Walter et al. (2021) explain that stress hormones biologically interfere with a crucial role the peptide hormone oxytocin plays in uterine activity which can ultimately slow labour progression. Effective communication is an essential strategy to reduce and manage anxiety during intrapartum care to reduce the release of stress hormones, reassure women, create rapport, feelings of safety, and promote self-confidence of the birthing woman (Baranowska et al., 2021 ). Women who experience effective communication during labour and birth report higher satisfaction with the birth experience and improved postnatal mental wellbeing (Nilsson et al., 2020; Ojelade et al., 2017 ). In addition, Bohren et al. (2017) found that reduced stress during labour and birth resulted in women less likely to have a neonate with a low five‐minute Apgar score (RR 0.62, 95% CI 0.46 to 0.85; 14 trials, 12,615 women). Evidence suggests the benefits of effective communication for mothers impacts both their own and their infant’s ongoing wellbeing with a systematic review by Uvnas-Mobey et al. (2020) also suggesting that effective communication may reduce stress that improves successful breastfeeding offering benefits to both the mother and neonate. Strengths & Limitations The evaluation has clearly outlined current shortfalls in the provision of interpreter provision during intrapartum care at the Midlands hospital, UK. Wider literature suggests communication issues during intrapartum care is a current challenge and this evaluation further highlights the need for research to further explore barriers and impact of not using interpreter provision for women who do not speak English during intrapartum care. The evaluation is limited to a small sample size within one geographical region in England, UK. Despite this, the paper raises pertinent issues to inform further research. Conclusion The service evaluation aimed to understand the extent in which interpreting services were accessed for women during intrapartum care at a Midlands maternity hospital in the UK. Findings indicated that 48 (22%) of women required interpreter provision, but only 11 (23%) of those women accessed it. The impact of having access to an ‘interpreter’ or ‘no interpreter’ was measured by analysing two outcomes, mode of birth and length of labour. The results indicate that mode of birth was not impacted by interpreter use, but that length of labour may be impacted by interpreter use. Length of labour for women who required an interpreter, but did not access the provision had a longer mean length of labour (M = 157.06, SD 114.27) vs the ‘interpreter’ accessed group (M = 65.25, SD 48.12). In addition, there was greater variance in length of labour between groups (381 vs 102) respectively. Despite differences in descriptive analysis, results were non-significant for both mode of birth (p = .262) and length of labour (p = .09). However, more research is needed with a larger and more geographically diverse sample to determine more accurate results. In addition, there is need for qualitative studies to explore barriers in effective communication through accessing interpreting provision. Declarations Ethics approval Ethics approval was deemed unnecessary according to national regulations (Health Research Authority [HRA], 2022). Consent to publish Consent to Publish declaration: not applicable Funding declaration No funding was received for this project. Competing interest declaration The authors do not have any competing interests to declare. Data Availability statement The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Author Contribution RF developed the research protocol and collected data and wrote the main manuscript. LPvW analysed the data. LPvW and RF wrote the and reviewed the manuscript Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Abdulle AA, Borrego N, Lundgren I. Midwives’ experiences of encountering immigrant women during labour and birth who do not master the host country’s language. A lifeworld hermeneutic study. Scand J Caring Sci. 2023. 10.1111/scs.13187 . Akinwotu E. (2020). If that’s not an option, the translator is a relative: an investigation into the challenges of medical translation in the NHS. BMJ, 368, m447. Available at: https://www.bmj.com/content/368/bmj.m447#:~:text=%E2%80%9CIf%20that%27s%20not%20an%20option,the%20translator%20is%20a%20relative Akselsson A, Westholm L, Small R, et al. Midwives’ communication with non-Swedish-speaking women giving birth: A survey from a multicultural setting in Sweden. Eur J Midwifery. 2022;6(June). 10.18332/ejm/148159 . Bains S, Skråning S, Sundby J, et al. Challenges and barriers to optimal maternity care for recently migrated women - a mixed-method study in Norway. BMC Pregnancy Childbirth. 2021a;21(1). 10.1186/s12884-021-04131-7 . Bains S, Sundby J, Lindskog BV, et al. Newly arrived migrant women’s experience of maternity health information: A face-to-face questionnaire study in Norway. Int J Environ Res Public Health. 2021b;18(14). 10.3390/ijerph18147523 . Baranowska B, Pawlicka P, Kiersnowska I, Misztal A, Kajdy A, Sys D, Doroszewska A. Woman's Needs and Satisfaction Regarding the Communication with Doctors and Midwives during Labour, Delivery and Early Postpartum. Healthc (Basel). 2021;9(4):382. 10.3390/healthcare9040382 . PMID: 33915688; PMCID: PMC8066117. Birmingham and Solihull Integrated Care System. Maternity update on the key risk areas. Cae Birmingham; 2024. Blennerhassett A. (2020) Language and Communication Service Needs Assessment: West Midlands Data Pack . Birmingham. Bradfield Z, Hauck Y, Duggan R, et al. Midwives’ experiences of learning and teaching being ‘with woman’: A descriptive phenomenological study. Nurse Educ Pract. 2020;43. 10.1016/j.nepr.2020.102699 . Bridle L, Bassett S, Silverio SA. We couldn’t talk to her: a qualitative exploration of the experiences of UK midwives when navigating women’s care without language. Int J Hum Rights Healthc. 2021;14(4):359–73. 10.1108/IJHRH-10-2020-0089 . Campbell S, Greenwood M, Prior S, et al. Purposive sampling: complex or simple? Research case examples. J Res Nurs. 2020;25(8):652–61. 10.1177/1744987120927206 . Care Quality Commission (CQC). (2024) University Hospitals Birmingham NHS Foundation Trust Inspection report . Filby A, McConville F, Portela A. What prevents quality midwifery care? A systematic mapping of barriers in low and middle income countries from the provider perspective. PLoS ONE. 2016;11(5). 10.1371/journal.pone.0153391 . Health Research Authority (HRA). (2022) Do I need NHS REC review? Available at: https://www.hra.nhs.uk Jenkinson C. (2023) Care Quality Commission: University Hospitals Birmingham NHS Foundation Trust Birmingham Heartlands Hospital Inspection report . Knight M, Bunch K, Patel R et al. (2022a) Saving Lives, Improving Mothers’ Care. Core report: Lessons learned to inform maternity care from the UK and Ireland Confedential Enquiries into Maternal Deaths and Morbidity 2018-20 . Oxford. Available at: Knight M, Bunch K, Patel R et al. (2022b) Saving lives, improving mothers’ care: Core Report: Lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2018–2020 . Kuliukas L, Bradfield Z, Costins P, et al. Midwifery students’: Developing an understanding of being ‘with woman’––A qualitative study. Midwifery. 2020;84. 10.1016/j.midw.2020.102658 . Kwan M, Jeemi Z, Norman R, et al. Professional Interpreter Services and the Impact on Hospital Care Outcomes: An Integrative Review of Literature. Int J Environ Res Public Health. 2023;20(6). 10.3390/ijerph20065165 . MacLellan J, McNiven A, Kenyon S. Provision of interpreting support for cross-cultural communication in UK maternity services: A Freedom of Information request. Int J Nurs Stud Adv. 2024;6. 10.1016/j.ijnsa.2023.100162 . Medical Research Council. (2022) Health Research Authority Decision Tool . Molina RL, Adams E, Aguayo R et al. (2022) Disparities in Comprehension of the Obstetric Consent According to Language Preference Among Hispanic/Latinx Pregnant Patients. Cureus . 10.7759/cureus.27100.=== Navodani T, Gartland D, Brown SJ, et al. Common maternal health problems among Australian-born and migrant women: A prospective cohort study. PLoS ONE. 2019;14(2). 10.1371/journal.pone.0211685 . Le Neveu M, Berger Z, Gross M. Lost in Translation: The Role of Interpreters on Labor and Delivery. Health Equity. 2020;4(1):406–9. 10.1089/heq.2020.0016 . Morris N, Haddad F. The Effect of Anxiety on the Course of Labor. In: McGuigan FJ, Sime WE, Wallace JM, editors. Stress and Tension Control 3. Boston, MA: Springer US; 1989. pp. 235–40. NICE. (2021) Antenatal Care Guidelines . Available at: NICE. (2023) Intrapartum care NICE guideline . Available at: https://www.nice.org.uk/guidance/ng235 (Accessed: 18 June 2024). Nilsson L, Thorsell T, Hertfelt Wahn E, Ekström A. Factors Influencing Positive Birth Experiences of First-Time Mothers. doi: 10.1155/2013/349124. Available online: https://www.hindawi.com/journals/nrp/2013/349124/ Ojelade OA, Titiloye MA, Bohren MA, Olutayo AO, Olalere AA, Akintan A, Oladapo OT, Fawole B. The Communication and Emotional Support Needs to Improve Women’s Experience of Childbirth Care in Health Facilities in Southwest Nigeria: A Qualitative Study. Int J Gynecol Obstet. 2017;139:27–37. 10.1002/ijgo.12380 . Origlia Ikhilor P, Hasenberg G, Kurth E, et al. Communication barriers in maternity care of allophone migrants: Experiences of women, healthcare professionals, and intercultural interpreters. J Adv Nurs. 2019;75(10):2200–10. 10.1111/jan.14093 . Rayment-Jones H, Dalrymple K, Harris J, et al. Project20: Does continuity of care and community-based antenatal care improve maternal and neonatal birth outcomes for women with social risk factors? A prospective, observational study. PLoS ONE. 2021a;16(5 May). 10.1371/journal.pone.0250947 . Rayment-Jones H, Harris J, Harden A, et al. Project20: interpreter services for pregnant women with social risk factors in England: what works, for whom, in what circumstances, and how? Int J Equity Health. 2021b;20(1). 10.1186/s12939-021-01570-8 . Reed R. Reclaiming Childbirth as Rite of Passage. 1st ed. Yandina: Word WItch; 2021. Sentell T, Chang A, Ahn HJ, et al. Maternal language and adverse birth outcomes in a statewide analysis. Women Health. 2016;56(3):257–80. 10.1080/03630242.2015.1088114 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 07 May, 2026 Reviews received at journal 28 Jan, 2026 Reviewers agreed at journal 28 Jan, 2026 Reviews received at journal 26 Jan, 2026 Reviewers agreed at journal 17 Jan, 2026 Reviewers invited by journal 14 Jan, 2026 Editor assigned by journal 12 Jan, 2026 Editor invited by journal 22 Dec, 2025 Submission checks completed at journal 19 Dec, 2025 First submitted to journal 19 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8288697","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":574821440,"identity":"baea2ba6-7074-4862-ab2d-189830a34515","order_by":0,"name":"Rachel Fucella","email":"","orcid":"","institution":"University Hospitals Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Rachel","middleName":"","lastName":"Fucella","suffix":""},{"id":574821441,"identity":"30e6c811-ef83-49a4-80d7-d51a35a1c760","order_by":1,"name":"Lauren Philp-von Woyna","email":"data:image/png;base64,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","orcid":"","institution":"University of Birmingham","correspondingAuthor":true,"prefix":"","firstName":"Lauren","middleName":"Philp-von","lastName":"Woyna","suffix":""}],"badges":[],"createdAt":"2025-12-05 14:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8288697/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8288697/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100547344,"identity":"4dbb1c54-21fb-4289-9cbc-648264634ed0","added_by":"auto","created_at":"2026-01-19 08:15:19","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":146623,"visible":true,"origin":"","legend":"","description":"","filename":"a.EvaluationofIntrapartumInterpreterProvision.docx","url":"https://assets-eu.researchsquare.com/files/rs-8288697/v1/82e90eeb23bfab9b20cb1d06.docx"},{"id":100448898,"identity":"c552bbe7-109a-47db-9640-cebf806939fc","added_by":"auto","created_at":"2026-01-16 19:32:19","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4515,"visible":true,"origin":"","legend":"","description":"","filename":"6748546161b74d06ae3e150c80082df6.json","url":"https://assets-eu.researchsquare.com/files/rs-8288697/v1/61aee32abbf79d7c45f63ddf.json"},{"id":100547315,"identity":"d28958c3-3ebf-4884-a6ac-b9fc470ea00a","added_by":"auto","created_at":"2026-01-19 08:15:15","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":86821,"visible":true,"origin":"","legend":"","description":"","filename":"6748546161b74d06ae3e150c80082df61enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8288697/v1/d2d306084818fa606f8c3f2c.xml"},{"id":100448904,"identity":"f8f7d96b-2903-4276-a80d-e732ea37bbeb","added_by":"auto","created_at":"2026-01-16 19:32:19","extension":"jpeg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1074,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8288697/v1/4bf13f4d4159d64df5fc95f7.jpeg"},{"id":100448899,"identity":"001bfc0a-bb3b-413e-89d2-b5ecea2053ef","added_by":"auto","created_at":"2026-01-16 19:32:19","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6485,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8288697/v1/da3e2de546a2bb6f637a5dfb.png"},{"id":100448902,"identity":"ddc7c12b-5383-4c1f-8e71-e8d2f6b7eea8","added_by":"auto","created_at":"2026-01-16 19:32:19","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":935,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8288697/v1/42524e692ca86bc6c4a8e12c.png"},{"id":100547790,"identity":"7a354b92-a1c1-4e56-8333-6c49445bdd4c","added_by":"auto","created_at":"2026-01-19 08:16:35","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":81680,"visible":true,"origin":"","legend":"","description":"","filename":"6748546161b74d06ae3e150c80082df61structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8288697/v1/cba9a0a955c037d7e63c7c27.xml"},{"id":100547627,"identity":"643a06ae-92e5-420f-95db-205201429b54","added_by":"auto","created_at":"2026-01-19 08:16:08","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":93231,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8288697/v1/d3ba9e9fb0a364ee13771e15.html"},{"id":100547416,"identity":"02afbeaa-6575-4ee2-b40c-8ff79bbe8d83","added_by":"auto","created_at":"2026-01-19 08:15:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":6585,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8288697/v1/2933af913d93e2c7ae63f9eb.png"},{"id":100554158,"identity":"e7b22c5d-8edd-4d55-9526-a2f34a3159c0","added_by":"auto","created_at":"2026-01-19 08:38:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":485732,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8288697/v1/a53d2f5e-6829-4ea4-9a1f-9deba9627ee5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"An Evaluation of Intrapartum Language Interpreter Provision and birth outcomes at a UK maternity hospital","fulltext":[{"header":"Problem or Issue and What is Already Known","content":"\u003cp\u003eAddressing language barriers through interpreter provision may improve women\u0026rsquo;s experiences of labour and birth as well as birth outcomes. Language barriers in healthcare have been identified as leading to lower levels of service user satisfaction and safety, as well as higher rates of adverse outcomes (Suphanchaimat et al., 2015; Kwan et al., 2023).\u003c/p\u003e\n\u003cp\u003eThe critical need for professional language interpretation services during intrapartum care is well-documented (Origlia Ikhilor et al., 2019; Le Neveu et al., 2020; Sentell et al., 2016). In the UK, a recent confidential enquiry into maternal deaths highlighted that non-English speaking women receive poorer care, with higher morbidity and mortality rates, emphasizing the need for interpreter services to be accessible throughout labour and delivery (Knight et al, 2022b).\u003c/p\u003e\n\u003cp\u003eDespite the UK\u0026rsquo;s National Institute for Health and Care Excellence (NICE) guidelines mandating that provision or offer of interpreter services for women who have difficulty understanding or speaking English is essential, findings in this evaluation indicated that only 23% of women received these services during their intrapartum care when it was required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat this Paper Adds\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis paper highlights a measurable difference between interpreter use and length of labour which has not previously been identified in current literature. Length of labour for women with \u0026lsquo;no interpreter\u0026rsquo; experienced a longer mean length of labour (M= 157.06, SD 114.27) when compared to the \u0026lsquo;interpreter\u0026rsquo; group (M= 65.25, SD 48.12) with greater variance in length of labour (381 vs 102 minutes), respectively. Despite this, results were found to be non-significant (p= .09), and no differences were found in mode of birth. The paper highlights the need for further evaluative projects or studies with larger samples to better examine language barriers, access to interpreter provision and labour and birth outcomes.\u0026nbsp;\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eProblem description\u003c/p\u003e \u003cp\u003eChildbirth. For many it is a time of great joy, but for some it is a time of significant vulnerability. The role of the midwife, as the Old English root of the title suggests, is to be alongside women through pregnancy, childbirth and beyond (Reed, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). At the heart of this ‘being with’ is the development of therapeutic relationship built on trust, with the bedrock of this trust being clear and open communication (Bradfield et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Kuliukas et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLanguage barriers obstruct channels of communication between a woman and her midwife and impact a woman’s experience of labour and birth which may in turn be associated with longer length of labour and mode of birth (Chioma et al., 2024). This evaluation aimed to understand the extent to which interpretation services were accessed for women during intrapartum care and examined the relationship between the provision of interpretation services, mode of birth, and length of labour.\u003c/p\u003e \u003cp\u003eAvailable knowledge\u003c/p\u003e \u003cp\u003eThe vulnerability of women in the perinatal period is a complex and multifaceted issue, but the specific problem of language barriers has been identified, both in academic literature and public policy (Knight et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022b\u003c/span\u003e; Viveiros and Darling, 2019; Bains et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021a\u003c/span\u003e; Filby et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; NICE, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). A Public Health England (PHE) report noted that women from minority ethnic communities, accessing healthcare in the Midlands, UK were less likely to confidently use English when compared to men in their communities suggesting language interpretation provision needs are higher in women’s health and maternity (Blennerhassett, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Internationally, Scandinavian studies have explored the experiences of midwives caring for women who do not speak the lingua franca (Abdulle et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Akselsson et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Bains et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021b\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021a\u003c/span\u003e). These studies highlight challenges of being ‘with woman’, the core of the midwife’s role, when linguistic barriers are present. These reflections were echoed by UK based study by Bridle et al(2021) where one participant described the pain of being unable to support a woman ‘through the most difficult experience of her life, because we couldn’t talk to her’ (Bridle et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, p.367). In addition, concerns were raised about inability to formally or thoroughly consent women during emergency procedures, including a case where health professionals explained they ‘couldn’t consent her for [caesarean] section – we just had to do it’ (Bridle et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, p.367).\u003c/p\u003e \u003cp\u003eProject20 (Rayment-Jones et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021b\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2021a\u003c/span\u003e) included longitudinal, qualitative studies that explored the views of non-English speaking women accessing two inner-city maternity services in the UK by undertaking interviews. Data was analysed using a thematic framework that identified barriers to accessing services associated with language needs, lack of choice, and concerns about confidentiality when interpreting services were used. Navodani et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) also found that poor provision of interpreting services means women are unable to disclose risk factors or communicate concerns (Rayment-Jones et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021b\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRationale\u003c/p\u003e \u003cp\u003eGlobally, language barriers in healthcare have been linked, through systematic literature reviews to lower levels of service user satisfaction and safety, as well as higher rates of adverse outcomes (Suphanchaimat et al., 2015; Kwan et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Focusing in on maternity services, the critical need for professional interpreting services, during the intrapartum period, has been clearly highlighted and explored across a range of geographic and linguistic contexts (Origlia Ikhilor et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Le Neveu et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Sentell et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Mothers and Babies: Reducing Risk through Audits and Confidential Enquires across the UK (MBRRACE) report clearly states that women who do not speak English receive poorer care, demonstrated by higher rates of morbidity and mortality (Knight et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022b\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022a\u003c/span\u003e). The report includes a critical recommendation – that every birthing person who requires it should have access to an interpreting service throughout the course of their labour and delivery (Knight et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022b\u003c/span\u003e). 1 in 5 maternal deaths reported by MBRRACE in 2018–2020 were women who were identified as speaking little to no English (Knight et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022a\u003c/span\u003e). Key issues identified were delays in care and missed risk factors and red flag signs which, if identified, may have significantly altered outcomes. Interpreting provision enables timely reporting of risk factors and red flag signs by women. Despite this, MacLellen et al. (2024) found a significant variance in the demand for, spending on, and provision of interpreting services across 100 healthcare facilities in the UK suggesting this area requires evaluation and research.\u003c/p\u003e \u003cp\u003eAim\u003c/p\u003e \u003cp\u003eThis service evaluation aimed to understand the extent in which interpreting services were accessed for women during intrapartum care at a Midlands maternity hospital and, examined the relationship between the provision of interpreting services, mode of birth, and length of labour.\u003c/p\u003e "},{"header":"Methodology","content":"\u003cp\u003eContext\u003c/p\u003e\u003cp\u003eThis evaluation was conducted at a Maternity Unit in the Midlands, UK. The hospital is situated near a linguistically and culturally diverse population with recent Census data indicating that up to 30% of the local population speak ‘little to no English’ (Waddington, 2022).\u003c/p\u003e\u003cp\u003eTherefore, within the specific context, use of language interpreting services for the large proportion of local women who require it during intrapartum care can indicate whether women are receiving high quality care which meets their needs (Jenkinson, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Filby et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). There are acknowledged inconsistencies in the use of interpreting services and availability of information in different languages (Jenkinson, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), but the direct and local impact on intrapartum outcomes is unknown. Locally, concerns have been raised about whether care is person-centred and holistic (CQC, 2024) and the Birmingham and Solihull Intragrated Care System (2024) highlighted the local critical and pressing challenges of providing care for a diverse population.\u003c/p\u003e\u003cp\u003eApproach \u0026amp; Measures\u003c/p\u003e\u003cp\u003eThe Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) framework (reference) was used to report the evaluation.\u003c/p\u003e\u003cp\u003eAll women who attended the maternity unit for intrapartum care from 19th February 2024- 3rd March 2024 were included in the evaluation. This period was selected to provide a succinct but not insignificant dataset which can be examined to inform improvements (Beake et al, 1997). Women were divided into groups as ‘requiring’ or ‘not requiring’ language interpretation services from details recorded in the maternal electronic records. Women were identified as ‘requiring’ interpretation services if a health professional had selected either ‘Non-English speaking’ or ‘Can’t speak or understand English’ during the early pregnancy booking appointment. This allowed for the most pertinent and relevant data to be collected (Campbell et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Quantitative, measurable outcomes collected data from maternal electronic records about whether interpreter use was documented during labour and type of service accessed (whether telephone, in person or video link), the length of labour in minutes and the mode of birth as vaginal, instrumental or caesarean birth. This was inclusive of planned caesarean births.\u003c/p\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003cp\u003e The SQUIRE guidelines are intended for reporting local interventions and their associated outcomes during the provision of care or practice that can improve the quality safety and value of healthcare (SQUIRE, 2022). In this evaluation, the intervention was defined as use of a language interpreter. The impact of receiving or not receiving a language interpreter where it was required was evaluated through measurable outcomes by extracting data from maternal notes about mode of birth and length of labour.\u003c/p\u003e\u003cp\u003eEthics\u003c/p\u003e\u003cp\u003eLocal permission was obtained, and the evaluation was registered with the local Clinical Audit Registration \u0026amp; Management System (CARMS) and Clinical Governance team. The evaluation does not meet the threshold stipulated by the UK’s Medical Research Council and Health Research Authority (2022) for a formal ethics review. Data was collected in a private office by the primary author who complied with UK General Data Protection Regulation (2016) and all data was appropriately anonymised and stored on a secure, password-protected device shared only with the authors. Data was deleted following analysis.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData collected was analysed using descriptive and inferential statistics. Descriptive elements were presented in readable charts to highlight key trends. Further analysis using Chi-squared and Kruskall-Wallis determined if outcomes associated with interpreter use were statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e223 women attended the hospital for intrapartum care during the evaluative period. 48 (22%) of women met the defined threshold for requiring an interpreter for intrapartum care. Table\u0026nbsp;1. Summarises the primary language requirements of the sample.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eTable\u0026nbsp;1: Primary Non-English Language Spoken\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrdu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBengali\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePashto\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSomali\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArabic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLanguage not recorded\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRomanian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDari\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBulgarian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSylheti\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTigrinya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDespite 48 (22%) of women requiring an interpreter, only 11 (23%) of the women received an interpreter during intrapartum care meaning 37 (77%) of women who required an interpreter did not receive care that included interpreting services. In one of the 37 cases where an interpreter was identified as required, a family member was recorded as the interpreter.\u003c/p\u003e \u003cp\u003eInterpreter use and mode of birth\u003c/p\u003e \u003cp\u003eThe sample results were divided into datasets of either \u0026lsquo;Interpreter\u0026rsquo; (interpreter needed and used) or \u0026lsquo;no interpreter\u0026rsquo; (interpreter required but not used). Data from each group was analysed to evaluate impact on measurable outcomes as, mode of birth and length of labour (in cases where labour occurred, n\u0026thinsp;=\u0026thinsp;20).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e. summarises 48 intrapartum cases grouped as \u0026lsquo;interpreter\u0026rsquo; and \u0026lsquo;no interpreter\u0026rsquo; and their mode of birth. Mode of birth is grouped into four categories, vaginal, Elective caesarean, emergency caesarean and instrumental birth. No interpreters were used for any elective caesarean births or any instrumental births in the evaluation. Among the birth outcomes, the \u0026lsquo;no interpreter\u0026rsquo; group were more likely to experience both emergency caesarean birth, 8 (16%) vs 5 (10%) and vaginal birth 18 (38%) vs 3 (6%). Chi-Squared test was undertaken to analyse whether interpreter use was associated with mode of birth. Results were non-significant (X2 (1, n\u0026thinsp;=\u0026thinsp;48)\u0026thinsp;=\u0026thinsp;2.674, P\u0026thinsp;=\u0026thinsp;.262). The results indicated that interpreter use had no significant effect on mode of birth suggesting that interpreter use may not influence this outcome.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInterpreter provision \u0026amp; mode of birth\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo interpreter group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterpreter group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal number of births\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElective caesarean birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency caesarean birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstrumental birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal number of births\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eInterpreter use and length of labour\u003c/p\u003e \u003cp\u003eTwenty women were identified as requiring an interpreter \u003cem\u003eand\u003c/em\u003e experienced labour. These women were divided into \u0026lsquo;interpreter\u0026rsquo; or \u0026lsquo;no interpreter\u0026rsquo; groups for evaluation of length of labour in minutes as a measurable outcome. Results found that women who did not have an interpreter experienced greater variance in their labour length (range, 17\u0026ndash;398, Mean\u0026thinsp;=\u0026thinsp;157.06, SD 114.27) when compared to women who had an interpreter (range 35\u0026ndash;137, Mean\u0026thinsp;=\u0026thinsp;65.25, SD 48.12). Labour length differences between the groups is illustrated in Diagram 1 and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e. These results suggest that labour is likely to be both longer and the length more varied when an interpreter is identified as needed but not used.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003e\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003c/div\u003e \u003c/caption\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable 3 Descriptive statistics: length of labour\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo interpreter group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterpreter group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e157.0625\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114.270713\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.127435\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eKruskall-Wallis test was undertaken to determine if length of labour was significantly longer with \u0026lsquo;no interpreter\u0026rsquo; compared to the \u0026lsquo;interpreter\u0026rsquo; group. The result is not significant (H statistic is 2.7273 (1, N\u0026thinsp;=\u0026thinsp;20), p\u0026thinsp;=\u0026thinsp;0.09865 at p\u0026thinsp;\u0026lt;\u0026thinsp;.05). A larger sample is required to evaluate a possible significant association between interpreter use and length of labour.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSummary\u003c/p\u003e \u003cp\u003eFindings indicate that when an interpreter was required during intrapartum care 77% of women did not receive an interpreter. In this evaluation, when an interpreter was required but not provided, it did not appear to impact the mode of birth, however, the sample size limits findings and further research is required. The evaluation found that not receiving interpretation services when required may contribute towards a longer labour length with Mean length of labour increasing without an interpreter, although this result was found to be non-significant. Results also suggest there is greater variance when an interpreter is not used which may suggest that the use of an interpreter influences individuals differently or other confounding variables need to be included in further research. Further evaluative projects or studies which examine this issue is needed.\u003c/p\u003e \u003cp\u003eOver the course of the study period, 223 women attended the study site to receive intrapartum care and 48 (22%) of these were identified during the intrapartum risk assessment as requiring an interpreter. These women spoke a diverse range of languages, as illustrated in Table\u0026nbsp;1. Despite the identification of the need for interpreters, and its classification as an intrapartum risk factor, only 11 (23%) have any documented record of interpreter provision.\u003c/p\u003e \u003cp\u003eAs stated in the contextual background it must be noted that, although discouraged, the use informal interpreters in the form of friends or family members can be requested. One case was found of a family member being used as an interpreter in the evaluative sample. Akinwotu (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) suggests using family members as interpreters presents ethical concerns surrounding confidentiality and veracity.\u003c/p\u003e \u003cp\u003eMode of birth\u003c/p\u003e \u003cp\u003eInterpreter provision did not significantly influence mode of birth, however, data highlighted some concerning features about care provided to non-English speaking women during labour and birth. Twelve women who identified as speaking little to no English underwent elective caesarean births. None of these had interpreter provision at any point during their intrapartum care, including upon admission to hospital, on the day of the procedure through to the commencement of postnatal care. This is despite the planned procedures allowing time for organisation of interpreting services prior to admission. Molina et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) supports that where an interpreter is required and not used, informed consent cannot be legitimately claimed raising ethical concerns about the consent and care provided to the twelve women who underwent elective caesarean births.\u003c/p\u003e \u003cp\u003eFurther examination reveals slightly improved rate of interpreter provision for women who underwent emergency caesarean births during the study period with 5 out of 13 women who had an emergency caesarean having an interpreter. Documentation revealed that during emergency situations, and specifically when the decision to proceed with a caesarean was made, the provision of an interpreter was prioritised. Records show specification regarding the form of interpreting service, most frequently telephone, alongside what information was communicated. In two cases, it was noted that multilingual staff communicated directly with women and their families. Although this is not provision of interpreter through a formal service, it provided insight about how staff overcame communication challenges in practice.\u003c/p\u003e \u003cp\u003eLength of labour\u003c/p\u003e \u003cp\u003eLength of labour was more variable and longer when no interpreter was used. Length of labour is thought to be influenced by effective continuous support during labour and birth which includes effective communication (Bohren et al., 2017). A Cochrane review by Bohren et al. (2017) found that where women receive continuous support, they are more likely to have a vaginal birth (RR 1.08, 95% CI 1.04\u0026ndash;1.12; 21 trials, 14,369 women) and their labours were shorter (MD -0.69 hours, 95% CI ‐1.04 to ‐0.34; 13 trials, 5429 women). Despite Bohren et al\u0026rsquo;s (2017) review including some lower quality evidence, the findings were supported by large samples and wider evidence. There is strong and longstanding evidence suggesting that psychological anxiety during labour and birth can lengthen labour through the release of stress hormones, such as cortisol (Morris and Haddad, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e1989\u003c/span\u003e). Walter et al. (2021) explain that stress hormones biologically interfere with a crucial role the peptide hormone oxytocin plays in uterine activity which can ultimately slow labour progression. Effective communication is an essential strategy to reduce and manage anxiety during intrapartum care to reduce the release of stress hormones, reassure women, create rapport, feelings of safety, and promote self-confidence of the birthing woman (Baranowska et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Women who experience effective communication during labour and birth report higher satisfaction with the birth experience and improved postnatal mental wellbeing (Nilsson et al., 2020; Ojelade et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). In addition, Bohren et al. (2017) found that reduced stress during labour and birth resulted in women less likely to have a neonate with a low five‐minute Apgar score (RR 0.62, 95% CI 0.46 to 0.85; 14 trials, 12,615 women). Evidence suggests the benefits of effective communication for mothers impacts both their own and their infant\u0026rsquo;s ongoing wellbeing with a systematic review by Uvnas-Mobey et al. (2020) also suggesting that effective communication may reduce stress that improves successful breastfeeding offering benefits to both the mother and neonate.\u003c/p\u003e \u003cp\u003eStrengths \u0026amp; Limitations\u003c/p\u003e \u003cp\u003eThe evaluation has clearly outlined current shortfalls in the provision of interpreter provision during intrapartum care at the Midlands hospital, UK. Wider literature suggests communication issues during intrapartum care is a current challenge and this evaluation further highlights the need for research to further explore barriers and impact of not using interpreter provision for women who do not speak English during intrapartum care. The evaluation is limited to a small sample size within one geographical region in England, UK. Despite this, the paper raises pertinent issues to inform further research.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe service evaluation aimed to understand the extent in which interpreting services were accessed for women during intrapartum care at a Midlands maternity hospital in the UK. Findings indicated that 48 (22%) of women required interpreter provision, but only 11 (23%) of those women accessed it. The impact of having access to an ‘interpreter’ or ‘no interpreter’ was measured by analysing two outcomes, mode of birth and length of labour. The results indicate that mode of birth was not impacted by interpreter use, but that length of labour may be impacted by interpreter use. Length of labour for women who required an interpreter, but did not access the provision had a longer mean length of labour (M = 157.06, SD 114.27) vs the ‘interpreter’ accessed group (M = 65.25, SD 48.12). In addition, there was greater variance in length of labour between groups (381 vs 102) respectively. Despite differences in descriptive analysis, results were non-significant for both mode of birth (p = .262) and length of labour (p = .09). However, more research is needed with a larger and more geographically diverse sample to determine more accurate results. In addition, there is need for qualitative studies to explore barriers in effective communication through accessing interpreting provision.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003cp\u003e Ethics approval was deemed unnecessary according to national regulations (Health Research Authority [HRA], 2022).\u003c/p\u003e \u003ch2\u003eConsent to publish\u003c/h2\u003e \u003cp\u003eConsent to Publish declaration: not applicable\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003edeclaration\u003c/p\u003e \u003cp\u003eNo funding was received for this project.\u003c/p\u003e \u003cp\u003eCompeting interest declaration\u003c/p\u003e \u003cp\u003eThe authors do not have any competing interests to declare.\u003c/p\u003e \u003cp\u003eData Availability statement\u003c/p\u003e \u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRF developed the research protocol and collected data and wrote the main manuscript. LPvW analysed the data. LPvW and RF wrote the and reviewed the manuscript\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbdulle AA, Borrego N, Lundgren I. Midwives\u0026rsquo; experiences of encountering immigrant women during labour and birth who do not master the host country\u0026rsquo;s language. A lifeworld hermeneutic study. Scand J Caring Sci. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/scs.13187\u003c/span\u003e\u003cspan address=\"10.1111/scs.13187\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkinwotu E. (2020). If that\u0026rsquo;s not an option, the translator is a relative: an investigation into the challenges of medical translation in the NHS. BMJ, 368, m447. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.bmj.com/content/368/bmj.m447#:~:text=%E2%80%9CIf%20that%27s%20not%20an%20option,the%20translator%20is%20a%20relative\u003c/span\u003e\u003cspan address=\"https://www.bmj.com/content/368/bmj.m447#:~:text=%E2%80%9CIf%20that%27s%20not%20an%20option,the%20translator%20is%20a%20relative\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkselsson A, Westholm L, Small R, et al. Midwives\u0026rsquo; communication with non-Swedish-speaking women giving birth: A survey from a multicultural setting in Sweden. Eur J Midwifery. 2022;6(June). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18332/ejm/148159\u003c/span\u003e\u003cspan address=\"10.18332/ejm/148159\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBains S, Skr\u0026aring;ning S, Sundby J, et al. Challenges and barriers to optimal maternity care for recently migrated women - a mixed-method study in Norway. BMC Pregnancy Childbirth. 2021a;21(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12884-021-04131-7\u003c/span\u003e\u003cspan address=\"10.1186/s12884-021-04131-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBains S, Sundby J, Lindskog BV, et al. Newly arrived migrant women\u0026rsquo;s experience of maternity health information: A face-to-face questionnaire study in Norway. Int J Environ Res Public Health. 2021b;18(14). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph18147523\u003c/span\u003e\u003cspan address=\"10.3390/ijerph18147523\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaranowska B, Pawlicka P, Kiersnowska I, Misztal A, Kajdy A, Sys D, Doroszewska A. Woman's Needs and Satisfaction Regarding the Communication with Doctors and Midwives during Labour, Delivery and Early Postpartum. Healthc (Basel). 2021;9(4):382. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/healthcare9040382\u003c/span\u003e\u003cspan address=\"10.3390/healthcare9040382\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 33915688; PMCID: PMC8066117.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBirmingham and Solihull Integrated Care System. Maternity update on the key risk areas. Cae Birmingham; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlennerhassett A. (2020) \u003cem\u003eLanguage and Communication Service Needs Assessment: West Midlands Data Pack\u003c/em\u003e. Birmingham.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBradfield Z, Hauck Y, Duggan R, et al. Midwives\u0026rsquo; experiences of learning and teaching being \u0026lsquo;with woman\u0026rsquo;: A descriptive phenomenological study. Nurse Educ Pract. 2020;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.nepr.2020.102699\u003c/span\u003e\u003cspan address=\"10.1016/j.nepr.2020.102699\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBridle L, Bassett S, Silverio SA. We couldn\u0026rsquo;t talk to her: a qualitative exploration of the experiences of UK midwives when navigating women\u0026rsquo;s care without language. Int J Hum Rights Healthc. 2021;14(4):359\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1108/IJHRH-10-2020-0089\u003c/span\u003e\u003cspan address=\"10.1108/IJHRH-10-2020-0089\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampbell S, Greenwood M, Prior S, et al. Purposive sampling: complex or simple? Research case examples. J Res Nurs. 2020;25(8):652\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1744987120927206\u003c/span\u003e\u003cspan address=\"10.1177/1744987120927206\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCare Quality Commission (CQC). (2024) \u003cem\u003eUniversity Hospitals Birmingham NHS Foundation Trust Inspection report\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFilby A, McConville F, Portela A. What prevents quality midwifery care? A systematic mapping of barriers in low and middle income countries from the provider perspective. PLoS ONE. 2016;11(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0153391\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0153391\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealth Research Authority (HRA). (2022) \u003cem\u003eDo I need NHS REC review?\u003c/em\u003e Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.hra.nhs.uk\u003c/span\u003e\u003cspan address=\"https://www.hra.nhs.uk\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJenkinson C. (2023) \u003cem\u003eCare Quality Commission: University Hospitals Birmingham NHS Foundation Trust Birmingham Heartlands Hospital Inspection report\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKnight M, Bunch K, Patel R et al. (2022a) \u003cem\u003eSaving Lives, Improving Mothers\u0026rsquo; Care. Core report: Lessons learned to inform maternity care from the UK and Ireland Confedential Enquiries into Maternal Deaths and Morbidity 2018-20\u003c/em\u003e. Oxford. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003c/span\u003e\u003cspan address=\"http://www.hqip.org.uk/national-programmes\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKnight M, Bunch K, Patel R et al. (2022b) \u003cem\u003eSaving lives, improving mothers\u0026rsquo; care: Core Report: Lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2018\u0026ndash;2020\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuliukas L, Bradfield Z, Costins P, et al. Midwifery students\u0026rsquo;: Developing an understanding of being \u0026lsquo;with woman\u0026rsquo;\u0026ndash;\u0026ndash;A qualitative study. Midwifery. 2020;84. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.midw.2020.102658\u003c/span\u003e\u003cspan address=\"10.1016/j.midw.2020.102658\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKwan M, Jeemi Z, Norman R, et al. Professional Interpreter Services and the Impact on Hospital Care Outcomes: An Integrative Review of Literature. Int J Environ Res Public Health. 2023;20(6). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph20065165\u003c/span\u003e\u003cspan address=\"10.3390/ijerph20065165\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacLellan J, McNiven A, Kenyon S. Provision of interpreting support for cross-cultural communication in UK maternity services: A Freedom of Information request. Int J Nurs Stud Adv. 2024;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijnsa.2023.100162\u003c/span\u003e\u003cspan address=\"10.1016/j.ijnsa.2023.100162\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMedical Research Council. (2022) \u003cem\u003eHealth Research Authority Decision Tool\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMolina RL, Adams E, Aguayo R et al. (2022) Disparities in Comprehension of the Obstetric Consent According to Language Preference Among Hispanic/Latinx Pregnant Patients. \u003cem\u003eCureus\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.27100.===\u003c/span\u003e\u003cspan address=\"10.7759/cureus.27100.===\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNavodani T, Gartland D, Brown SJ, et al. Common maternal health problems among Australian-born and migrant women: A prospective cohort study. PLoS ONE. 2019;14(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0211685\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0211685\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLe Neveu M, Berger Z, Gross M. Lost in Translation: The Role of Interpreters on Labor and Delivery. Health Equity. 2020;4(1):406\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1089/heq.2020.0016\u003c/span\u003e\u003cspan address=\"10.1089/heq.2020.0016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorris N, Haddad F. The Effect of Anxiety on the Course of Labor. In: McGuigan FJ, Sime WE, Wallace JM, editors. Stress and Tension Control 3. Boston, MA: Springer US; 1989. pp. 235\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNICE. (2021) \u003cem\u003eAntenatal Care Guidelines\u003c/em\u003e. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003c/span\u003e\u003cspan address=\"http://www.nice.org.uk/guidance/ng201\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNICE. (2023) \u003cem\u003eIntrapartum care NICE guideline\u003c/em\u003e. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nice.org.uk/guidance/ng235\u003c/span\u003e\u003cspan address=\"https://www.nice.org.uk/guidance/ng235\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (Accessed: 18 June 2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNilsson L, Thorsell T, Hertfelt Wahn E, Ekstr\u0026ouml;m A. Factors Influencing Positive Birth Experiences of First-Time Mothers. doi: 10.1155/2013/349124. Available online: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.hindawi.com/journals/nrp/2013/349124/\u003c/span\u003e\u003cspan address=\"https://www.hindawi.com/journals/nrp/2013/349124/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOjelade OA, Titiloye MA, Bohren MA, Olutayo AO, Olalere AA, Akintan A, Oladapo OT, Fawole B. The Communication and Emotional Support Needs to Improve Women\u0026rsquo;s Experience of Childbirth Care in Health Facilities in Southwest Nigeria: A Qualitative Study. Int J Gynecol Obstet. 2017;139:27\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ijgo.12380\u003c/span\u003e\u003cspan address=\"10.1002/ijgo.12380\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOriglia Ikhilor P, Hasenberg G, Kurth E, et al. Communication barriers in maternity care of allophone migrants: Experiences of women, healthcare professionals, and intercultural interpreters. J Adv Nurs. 2019;75(10):2200\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jan.14093\u003c/span\u003e\u003cspan address=\"10.1111/jan.14093\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRayment-Jones H, Dalrymple K, Harris J, et al. Project20: Does continuity of care and community-based antenatal care improve maternal and neonatal birth outcomes for women with social risk factors? A prospective, observational study. PLoS ONE. 2021a;16(5 May). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0250947\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0250947\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRayment-Jones H, Harris J, Harden A, et al. Project20: interpreter services for pregnant women with social risk factors in England: what works, for whom, in what circumstances, and how? Int J Equity Health. 2021b;20(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12939-021-01570-8\u003c/span\u003e\u003cspan address=\"10.1186/s12939-021-01570-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReed R. Reclaiming Childbirth as Rite of Passage. 1st ed. Yandina: Word WItch; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSentell T, Chang A, Ahn HJ, et al. Maternal language and adverse birth outcomes in a statewide analysis. Women Health. 2016;56(3):257\u0026ndash;80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/03630242.2015.1088114\u003c/span\u003e\u003cspan address=\"10.1080/03630242.2015.1088114\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"interpreting services, language, intrapartum, labour and birth, midwife, evaluation","lastPublishedDoi":"10.21203/rs.3.rs-8288697/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8288697/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eWomen who have difficulty understanding or speaking English receive poorer care with higher morbidity and mortality rates, emphasizing the need for interpreter services to be accessible throughout labour and delivery. In addition, addressing language barriers through interpreter provision may improve women’s experiences of labour and birth, as well as birth outcomes.\u003c/p\u003e\n\u003cp\u003eAim\u003c/p\u003e\n\u003cp\u003eThe aim of this study was to examine the extent in which interpretation services were accessed for women requiring the provision during intrapartum care and its relationship with outcomes defined as, mode of birth, and length of labour.\u003c/p\u003e\n\u003cp\u003eMethods\u003c/p\u003e\n\u003cp\u003eA service evaluation methodology\u003c/p\u003e\n\u003cp\u003eFindings\u003c/p\u003e\n\u003cp\u003e223 hospital intrapartum records were reviewed over a two-week study period at one maternity hospital. 48 (22%) women met the study inclusion criteria of whom 11 (23%) received intrapartum interpreter provision. Results indicate that mode of birth was not impacted by interpreter use (p= .262), but that length of labour may be impacted by interpreter use. Length of labour for women with ‘no interpreter’ had a longer mean length of labour (M= 157.06, SD 114.27) vs the ‘interpreter’ group (M= 65.25, SD 48.12) with greater variance in length of labour (381 vs 102 minutes) respectively. Despite this, results were found to be non-significant (p= .09).\u003c/p\u003e\n\u003cp\u003eConclusion\u003c/p\u003e\n\u003cp\u003eLength of labour may be influenced by effective continuous support during labour and birth, including effective communication that addresses any language barriers. This study suggests that interpreter provision may aid labour progression, although further research is required with larger sample sizes.\u003c/p\u003e","manuscriptTitle":"An Evaluation of Intrapartum Language Interpreter Provision and birth outcomes at a UK maternity hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-16 19:32:14","doi":"10.21203/rs.3.rs-8288697/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-07T17:40:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-28T16:45:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"28265779530315151973842047430890409473","date":"2026-01-28T16:08:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-26T14:13:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151084016823912228691019398955318925255","date":"2026-01-17T14:43:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-14T12:11:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-13T03:25:17+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-22T05:37:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-19T14:08:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-12-19T13:54:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"330324ee-8eb1-4821-a85e-a38a3c674f9e","owner":[],"postedDate":"January 16th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-07T17:40:16+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T17:54:29+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-16 19:32:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8288697","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8288697","identity":"rs-8288697","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}