Many immigrant and ethno-cultural groups in Canada face substantial barriers to accessing health care including language barriers. This study identified the nature of communication difficulties in maternity services from the perspectives of immigrant women, health care providers and social service providers in a small city in southern Alberta, Canada. We identified four main themes including verbal communication, unshared meaning, non-verbal communication to build relationships, and trauma, culture and open communication. Communication difficulties extended beyond matters of language competency to those encompassing non-verbal communication and its relation to shared meaning as well as the interplay of underlying pre-migration history and cultural factors which affect open communication, accessible health care and perhaps also maternal outcomes. Communication challenges may be experienced by all parties, yet those within health care management and professional bodies are responsible to ensure that providers are equipped with the skills necessary to facilitate culturally appropriate care.