© 2019 Foundation for the Sociology of Health & Illness Healthcare encounters involving participants from diverse linguistic backgrounds are becoming more common due to the globalisation of health care and increasing migration levels. Research suggests that this diversity has a significant impact on health outcomes; however less is known about how it is managed in the actual consultation process. This article presents an analysis of antenatal screening consultations video recorded in Hong Kong, using conversation analysis. We consider how the use of a second or subsequent language impacts on these consultations, and on discussions and decisions about further action. The presence or absence of shared first language did not appear to affect the extent to which particular courses of action were promoted or recommended. Recommendations were a common occurrence across consultations with and without shared first language. However, we argue that the routine use of recommendations can be consequential, as second language speakers may have more limited resources to interrogate or contest these. This finding has implications for the ability for professionals to maximise patient involvement in decision-making.