Lost in Translation

Sasha is a 38 year old mother to eight children. She has had 5 caesarean births, the latest being only 4 weeks ago. The surgeon who delivered her last baby has informed Sasha that if she gets pregnant again, the risks to both her and her baby are extreme, and the most likely outcome is that they will both die. However, Sasha is from a culture where the husband makes all the decisions, and her husband does not believe in contraception. Sasha does not speak any english, and due to his beliefs her husband will not discuss contraception with her. Your final maternity visit with Sasha is scheduled for a time when her husband will be at work, however your organisation is not able to make an interpreter available at that time to translate between you. Being an immigrant, Sasha has no family support and cannot drive, so you believe that if you do not discuss her options with her now she will not be able to consult her GP or other health professional without her husband finding out. Sasha's oldest daughter, aged 14, speaks both english and her native language, and is now your only way of communicating with Sasha.