Interactional work and the pursuit of accuracy in maternity interpreting: a qualitative analysis of interpreters’ experiences

Abstract Background Effective communication is fundamental to safe, equitable maternity care, yet language barriers remain a persistent challenge for migrant women. While professionally trained interpreters (PTIs) improve access and patient experience, interpreted consultations introduce challenges in relation to accuracy, impartiality, and cultural mediation. Within UK maternity services, variability in interpreter training and limited clinician understanding of the interpreter role contribute to concerns about trust, fidelity of information, and informed consent. Methods This qualitative interview study forms part of a wider implementation project examining the use of PTIs in maternity services in England. Guided by Normalisation Process Theory, we explored interpreters’ sense-making (coherence) and interactional work (collective action) within clinical encounters. Between January and May 2025, 28 interpreters with recent maternity experience were recruited and interviewed. Interviews were audio-recorded, transcribed verbatim, and analysed thematically using NVivo, with coherence and collective action as sensitising concepts. Interim findings were discussed with women with lived experience of maternity interpreting to refine analysis. Results Interpreters described navigating persistent tensions between impartiality, accuracy, and the need for cultural and emotional mediation. Three interrelated themes were identified: (1) Impartiality and boundary tensions, highlighting interpreters’ efforts to maintain professional distance amid emotional labour and expectations from women and clinicians; (2) Accuracy and fidelity in practice, showing how achieving accurate understanding often required interpreters to actively intervene, reframe information, or seek clarification, sometimes in tension with strict neutrality; and (3) Cultural and linguistic mediation, demonstrating interpreters’ critical but under-recognised role in explaining cultural norms, managing dialect differences, and supporting health literacy. Face-to-face interpreting and continuity enhanced accuracy and trust, while remote interpreting made communication and interaction more difficult. Conclusions Interpreting in maternity care is a dynamic, relational practice that extends beyond verbatim translation. Interpreters act as active contributors to communication, balancing ethical principles with patient understanding and safety. Clearer role expectations, standardised interpreter training, and clinician education on working with interpreters are essential to support this complex work and improve equity and quality in maternity care.