Built for the real world: Community Midwives on transforming maternity technology

By Holly Edmundson, NIHR Pre-doctoral Fellow & Community Midwife

Community midwives provide highly skilled care during pregnancy, birth, and the postnatal period. We work in GP surgeries, midwifery-led units, community centres, and women’s homes. We assess risk, manage complications, and offer reassurance during an often-worrying time.

While the role is rooted in woman-centred care, it also relies on physical tools, such as blood pressure monitors, urinalysis sticks, and fetal dopplers. When equipment falls short, so can our ability to deliver timely, effective diagnoses and treatment for poor maternity and neonatal health, putting mother and baby at risk

When it comes to this kind of health tech, and because it can be so important to the type of care we deliver as midwives, we wanted to know the people using it in the real world thought: what works, what doesn’t, and what’s missing. We interviewed 13 community midwives across England and Wales about the health technology they use.

So, according to the very users of such health tech, what should we be asking when designing or buying maternity tech?

Based on the study findings, here are six essential questions to guide better decision making.

1. Will this product improve clinical decision making, reduce hospital-based care, or support clinician time management?

Improving productivity is a central goal of NHS policy. It’s often framed as a way to improve services and make the system more sustainable. But for community midwives, it’s more than a political talking point – it’s a daily challenge.

Take the management of iron deficiency, for example. A midwife might take a blood sample – if the equipment is available – and then transport it to hospital, often in their own time. In some Trusts, women are referred elsewhere for testing. The midwife then checks for results, which can appear with delays. This requires regular follow-up or asking colleagues to check on their behalf. Once the result is back, they must document it, tell the patient, and arrange any treatment.

Midwives were clear: new tech must simplify care, not complicate it. They valued tools that helped them make informed decisions without adding to an already demanding workload. The midwives saw Point-Of-Care-Tests (POCTs) for anaemia or infections as useful. Similarly, several felt that portable ultrasound (for confirming fetal presentation) would reduce referrals and speed up planning.

2. Has this product been designed specifically for a maternity population? Could it cause harm or disturb physiological labour?

Maternity care needs a sensitive, tailored approach. Some midwives said that certain equipment didn’t feel designed with pregnancy in mind – or for women’s comfort and dignity. For example, oral thermometers were described as intrusive during labour. Others mentioned that changing BP cuffs for women with larger arms could feel stigmatising.

Designing for maternity means thinking beyond function – and considering the emotional and physical landscape of pregnancy and birth.

3. Is the quality sufficient for transport, temperature changes, and frequent use?

Community midwives don’t work from a fixed base. We travel between visits with our equipment in the car, exposed to wear and tear and changing temperatures.

Durability and portability were major issues in the interviews. Dopplers held together with tape. Thermometers failing after a few hot days in a boot. Heavy scales described as “a back injury waiting to happen.”

Equipment must be designed for the way we actually work – not for hospital clinics that rarely reflect our day-to-day. If something is awkward, fragile, or unreliable, even well-intentioned clinicians may avoid using it. Especially in a workforce already under pressure.

Designing tech that’s practical, robust, and intuitive doesn’t just support safe care – it supports consistent and fair care, too.

4. Is the price point realistic for widespread use?

Cost came up a lot – not just the price of new tech, but the cost of not having it.

Many midwives shared equipment with colleagues, which meant detours, handovers, or delays. Some had bought their own equipment due to poor quality or lack of supply. Others relied on charity donations for essentials like jaundice monitors.

When tight budgets drive procurement, staff often make up the shortfall. This affects morale, consistency of care, and patient safety. Affordable, scalable tools are essential to avoid postcode lotteries in provision.

5. Is there evidence this tool is accurate and reliable in maternity care?

Midwives weren’t looking for gadgets. They wanted tools they could trust - that work and make a difference.

Some had seen promising tech introduced, then withdrawn due to accuracy issues. This included tests for amniotic fluid, to assess if someone's ‘waters’ have broken. Experiences like these don’t only affect trust in a specific product. They can shake confidence in novel equipment generally.

6. Are there guidelines to support clinical decision making?

Midwives were proud of their distinct expertise and didn’t want to become “obstetric units on wheels.” They wanted technology that supported their clinical judgement and practical skills.

They also wanted guidance that respected professional autonomy. When carrying out a test, midwives want to be confident it’s clinically justified. There was concern that rigid protocols could turn technology use into box-ticking exercises. This came up in relation to carbon monoxide monitoring (used to support smoking cessation), where targets clashed with what midwives felt was appropriate.

If tech is to be used effectively, it must come with clear guidance, appropriate training, and decision-making pathways that reflect the values of community midwifery – continuity, holistic care, and trust.

A personal perspective

Before leading this research, I hadn’t given much thought to whether health tech could help address some of the challenges I faced in my role as a community midwife. Many of the midwives I spoke to said the same. No one had asked them what they needed – not when it came to equipment, or the systems that shape its use.

When you don’t think your voice will be heard, and you’re too busy for reflection, it’s hard to imagine change. You work around the issues, make do, and get on with it.

Over time, though, the cracks start to show. In a system where health technology is rarely optimised – and where time and energy are constantly stretched – I’ve seen this. A test not performed because the equipment wasn’t available; an abnormal lab result not actioned; delays responding to a concerning vital sign due to doubts about the reliability of the kit measuring it.

This study created space to reflect on something often overlooked: the quiet but critical role of health technology in enabling safe care.

The implications

This study shows that community midwives are open to innovation but are also cautious.

When introducing new tech, midwives want to be sure it has a clear purpose and will enhance the care they give. They want it to complement their expertise and simplify their work. As important is making sure the equipment is reliable, portable, and built for the realities of everyday practice.

Whether you're a developer, buyer, or policymaker, these six questions offer a place to start. Let’s make sure health tech isn’t only theoretically useful. It should be usable, trusted, and valued by those providing care on the frontline.

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Edmundson, H., Glogowska, M., Hayward, G. et al. Exploring the use of health technology in community-based midwifery care – an interview study. BMC Pregnancy Childbirth 25, 284 (2025). https://doi.org/10.1186/s12884-025-07406-5