Importance of Oral Communication in English as a Non-Native Language in Maternity Service in Lithuania: A Narrative Review

Effective communication plays a vital role in ensuring quality healthcare services, especially in sensitive settings like maternity services. In this context, the accurate use of language, including appropriate and specific vocabulary, is crucial. Lexical analysis, the study of vocabulary and its usage, is an essential aspect of oral communication in maternity services [1]. Lexical analysis in maternity services and oral communication is very important. The field of maternity services involves a vast array of medical terms and concepts. By conducting lexical analysis, healthcare professionals can identify and employ the most appropriate terminology, ensuring precise and clear communication. This helps prevent misunderstandings and confusion among healthcare providers, patients and their families [2]. Regarding the [3], effective communication in maternity services is not limited to healthcare professionals. Patients and their families must comprehend the information provided to make informed decisions. Lexical analysis ensures that medical terms are explained in layman’s terms, increasing patient understanding and engagement. This fosters a sense of empowerment and facilitates active participation in decision-making processes. Brondi et al. [4] describes that maternity services cater to diverse populations with varying cultural backgrounds and languages. Lexical analysis assists in identifying appropriate terminology and culturally sensitive language, addressing the unique needs of different communities. By adapting vocabulary and communication styles, healthcare providers can bridge language barriers, enhance trust, and improve the overall patient experience [4].

Even if lexical analysis is very important in the medical field, there are a variety of difficulties while there is lexical analysis in oral communication in midwifery or nursing fields. Cao et al. [5] describes that the field of medicine, including maternity services, constantly evolves with new discoveries, technologies, and treatment options. This poses a challenge for lexical analysis as professionals must stay updated with the latest vocabulary and ensure its accurate usage in oral communication. Continuous education and training are essential to address this challenge effectively [5]. Rajput [6] writes that medical professionals may inadvertently use jargon and technical language that may be unfamiliar to patients. Lexical analysis helps identify such terms and encourages the use of plain language, ensuring effective communication. It is crucial to strike a balance between professional terminology and patient-friendly language to convey information accurately while promoting understanding [6]. Healthcare professionals working in maternity services should engage in continuous learning and professional development programs. These programs should focus on improving lexical analysis skills, enhancing vocabulary usage, and staying abreast of new terminology and guidelines. This enables practitioners to provide up-to-date and accurate information to patients and their families [7].

The authors describes that lexical analysis plays a critical role in oral communication within maternity services, enabling precise, clear and patient-centered interactions. By identifying and utilizing appropriate vocabulary, healthcare professionals can ensure effective communication, promote patient understanding and build trust. Despite the challenges posed by rapidly evolving terminology and technical jargon, ongoing professional development, patientcentered communication, and interdisciplinary collaboration can help overcome these obstacles [2,4,7]. Speech is an important way to ensure that women’s voices are heard and that they are empowered to make decisions. In practice, this means that midwives need to take seriously the importance of foreign language use in the provision of midwifery services. This is not only to respect women’s views and ensure that they can make their own decisions, but also to respect their human rights. This requires careful use of languages, reflection on midwives’ practice as nurses, listening to women’s expectations, and communicating clearly and respectfully with patients to help them navigate the complexities of midwifery services. As highlighted in the World Health Organization (WHO) framework for improvement of the quality of care for pregnant women during childbirth, effective communication between maternity care providers and women in labour, using simple and culturally acceptable methods, is recommended: “Offering the woman and her family the information they need in a clear and concise manner (in the language spoken by the woman and her family), avoiding medical jargon, and using pictorial and graphic materials when needed to communicate processes or procedures” health systems should ensure that maternity care staff are trained to national standards for competence in interpersonal communication and counselling skills [8].

Continuous support during labour may improve outcomes for women and infants, including an increased number of instances of spontaneous vaginal birth, shorter duration of labour, decreased numbers of Caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute Apgar score, and negative feelings about childbirth experiences [9]. There are about 11 million people in Germany whose mother tongue is not German [10]. Many of these people have difficulties communicating in German and therefore are dependent on external help. The language barrier affects between 2.5% and 5% of all patients in the healthcare sector. The situation is similar in other European countries [11]. This means that healthcare systems are facing the challenge of finding ways to solve communication problems when the patient and the doctor are of different nationalities and cannot find ways to communicate. This is necessary not only to ensure patient-centered care but also to ensure a legally compatible approach to providing information on medical interventions and obtaining informed consent [10].

This is also the subject of a study conducted by Winn [12] and colleagues, who share their insights in their study. It shows that health professionals providing services to refugee women face challenges such as difficulties in navigating the healthcare system, language barriers, cultural barriers, such as managing traditional gender dynamics of wanting only women to provide healthcare. Effective communication in the provision of health services provides an opportunity to build women’s trust in the health care system, to ease concerns or anxiety, and to encourage regular access to regular preventive health care services in order to preserve their health and that of their children. In addition, antenatal care providers also play an important role in connecting women with social services, antenatal groups, and other support groups during pregnancy [12]. International migration continues to grow rapidly. The estimated number of international migrants has increased over the past five decades. The total estimated 281 million people living in a country other than their countries of birth in 2020 was 128 million more than in 1990 [13]. Thus, we can see that migration is very popular in the world and in Europe, which leads to problems such as a lack of knowledge of a foreign language and difficulties in accessing health services or communicating with health professionals.

Fair [14] with colleagues (2020), looked at the experiences of pregnancy, childbirth and postnatal care of immigrant women in European countries. One of the problems that women stated was “We don’t understand each other“ [14]. Women faced significant language barriers in the new country and felt that their language difficulties made them problem patients, which impacted their relationship with their healthcare specialists. Even when the woman had sufficient language skills, they still often lacked the vocabulary to cope with medical terminology [14]. And this is another problem that has emerged: the use of medical terms, which leads to patient mistrust of healthcare professionals and the services they provide.

In German hospitals, the most common method used to address language barriers is to have relatives translate for patients or to have multilingual medical staff in the hospital. However, most authors may differ in their views. One of the articles states: Get your professional staff members who speak other languages fluently certified for their skills and help them obtain medical interpreter training” [15].

The article states that family members, especially children under the age of 18, should not act as interpreters except in extenuating circumstances, such as an immediate threat to life. Using a close family member to help you translate medical terms runs the risk that some terms or words may not be translated correctly. It is also possible that a family member may feel uncomfortable and reluctant to translate certain information about sexual health, substance abuse, or terminal diagnosis [15]. The quality of this language mediation by untrained laypersons was often limited, which can affect health care outcomes. Using professional interpreters was associated with significantly better health care outcomes and, particularly in the form of interpretation via telephone, was a flexible and cost-effective approach [11]. Other European countries, including Norway, are facing similar challenges. Viken conducted a content analysis study and described coping strategies for Norwegian migrant women living in the country. The main strategy that has emerged is to maintain traditions and integrate women into Norwegian society. Another important strategy is being open to new opportunities, which involves the willingness and efforts of migrant women to learn Norwegian by taking part in “The Introductory Programme”. Active participation in a new environment can increase women’s abilities, and improvement of language skills can help women understand health information and social structures in Norwegian society independently, as there is no need to rely on translation by family members and interpreters [16].

The language barrier in medical institutions is a pressing issue in our country today. With the increasing number of immigrants from other countries and foreign students in Lithuania, it is becoming more and more common to find healthcare professionals who do not speak Lithuanian. Not knowing the local language gives patients the image of an unreliable, unqualified specialist, often underestimating their capabilities. In this case, communication becomes difficult and inaccurate. Communication is an essential clinical skill that, if performed competently and effectively, helps to establish a relationship of trust between medical staff and patients [17]. According to the Official statistics portal, 145,118 foreign citizens will live in Lithuania in 2022. Their share in the total population of Lithuania is steadily increasing and amounts to 5.1%. Compared to 2021, the number of foreigners is higher by 60%. The majority of foreign immigrants are citizens of Ukraine and Belarus (about 31% of all immigrants). Most EU nationals come from Latvia, Italy, or Germany. Not knowing the local language gives patients the image of an unreliable, unqualified professional, often underestimating their capabilities. In this case, communication becomes difficult and inaccurate. Verbal communication can be both positively and negatively reinforced by non-verbal means, such as artefacts (clothing and other clothing that reflects the message), tactile means (touch that affects attitudes and feelings), chronemics (the perception and use of time), kinesics (body language) or proxemics (the use of the physical and personal terrain) [18]. English has been the most important and popular language in Europe for many years. In missions organized by the European Union, English is the preferred language due to the diversity of nationalities of staff and patients [19]. Often when medical staff are confronted with a patient who does not speak their mother tongue, they begin to look for ways to communicate with the patient and to provide them with the necessary care.

Interpreters are one of the three components of a three-factor equation consisting of more dominant speakers, less dominant speakers and an interpreter. Regardless of the role interpreters play in an interlingual setting, they are essential for communication with those who do not speak the ‘majority’ language [20]. However, there can be observed that interpretive support may not always be helpful. Patients who require medical interpretation in a healthcare setting are generally less satisfied with the services provided by medical providers. Lack of proper medical translation is a cause of increased anxiety for patients, higher rates of visual impairment in type 2 diabetes, and more medical errors in clinical diagnosis. Patients with language barriers and cultural differences are also less likely to seek mental health care [21]. This article also discusses some of the possible solutions to the problem of miscommunication. For patients who frequently misunderstand the reasons for discharge, the hospital can print instructions in the language paid for the patient, and a detailed explanation by an interpreter should also be provided. Healthcare professionals with limited interpreting skills can use the services of an interpreter [21]. In summary, the dominance of English in international communication, particularly in the medical field. English is widely used in many areas around the world and has become an essential part of world society, culture, and economy. In the medical field, English has become the lingua franca, with the majority of scientific literature, articles, and visual materials accessible in English.

A. The information provided by the midwives must be understood by the birthing mother. Which means that the language must be accessible. Scientific literature analysis shows that communication in the health care system occupies more than 80 percent of all work. That means communication is one of the most important linguistic aspects in maternity service. Thus, it can be concluded that communication is one of the linguistic components, without which maternity services cannot be provided.
B. Communication as a linguistic part consists of verbal and non-verbal communication and accessible information for women.

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