Beyond the Clinic: Midwife-Led Digital Care Models for Equity and Continuity in Maternal Health

Maternal healthcare access remains uneven across urban, rural, and remote regions, particularly for communities experiencing socioeconomic disadvantage, geographic isolation, or cultural barriers. In many of these settings, women face significant challenges in receiving consistent, timely, and culturally safe care throughout their pregnancy journey. Midwives, as primary caregivers in pregnancy and postnatal care, are uniquely positioned to reduce these gaps through continuity models of care. However, the traditional model of in-person visits may not always be practical or sufficient, particularly in the context of a strained health workforce and geographic isolation.

Digital health presents a powerful opportunity to expand midwife-led care. From telehealth consultations and mobile health applications to wearable monitoring devices and secure messaging, digital models can extend care beyond the clinic walls. These innovations offer a scalable solution to workforce constraints and rising pregnancy complexities, while still centring the relational strength of midwifery-led care. Importantly, digital midwifery enables personalised, accessible, and context-sensitive services, fostering deeper connections and trust between midwives and the women they care for (Sandall et al., 2016).

The Evolution of Midwifery Through Digital Models

Digital midwifery is not simply a matter of technology but a reimagining of how presence, continuity, and support are provided. Telehealth platforms have enabled midwives to conduct remote antenatal education classes, regular check-ins for reassurance, mental health screening, and emergency triaging. These services, initially accelerated in response to the COVID-19 pandemic, have revealed long-term utility and effectiveness in maternal care delivery (Raynes-Greenow et al., 2021).

Beyond virtual consultations, mobile apps are increasingly being co-designed with midwives and mothers to facilitate communication, provide evidence-based educational resources, and support shared decision-making. These digital tools can include features like appointment reminders, symptom trackers, fetal movement logs, breastfeeding guidance, and postpartum mood screening. When linked with electronic health records, they support seamless care transitions between community midwives, general practitioners, and hospital-based obstetric teams, thus enhancing care coordination and clinical safety.

Digital models can also support postpartum care, an area often under-resourced in many maternal health systems. Virtual peer support groups, video-based lactation counselling, and app-based postnatal assessments are helping new mothers navigate a critical and vulnerable period, even from the comfort of their homes.

Equity and Cultural Safety in Remote Care

Equity is a cornerstone of high-quality maternal care, and digital midwifery holds particular promise for addressing disparities. For Indigenous, refugee, and migrant populations, who often encounter systemic racism, language barriers, and healthcare mistrust, technology can serve as both a bridge and a buffer. It allows for care that is both local and connected, preserving continuity while integrating specialist input when necessary.

However, equity in digital health is not automatic. To truly reduce disparities, digital models must be culturally safe and co-designed with communities. This includes offering services in multiple languages, embedding Indigenous and culturally appropriate frameworks, and designing platforms that are easy to use on low-cost mobile devices with limited connectivity. When developed through participatory approaches, such models are more likely to resonate with users and achieve sustained engagement.

Evidence strongly supports the effectiveness of midwife-led continuity of care, particularly for vulnerable groups. A Cochrane review by Sandall et al. (2016) showed that such models reduce preterm births, increase maternal satisfaction, and lower intervention rates. Digital extensions of these models have the potential to amplify those benefits by overcoming logistical barriers, reducing care dropout rates, and ensuring timely interventions (Evans et al., 2020).

Evaluating What Works: Measuring Digital Midwifery

While digital innovation is promising, it must be accompanied by rigorous evaluation. Understanding what works, for whom, and under what circumstances is essential to scale and sustain effective models. Evaluation metrics must extend beyond user satisfaction to include maternal and neonatal health outcomes, clinician workload and wellbeing, service accessibility, and cost-effectiveness.

Qualitative research also plays a critical role. Capturing the lived experiences of women and midwives who use digital tools provides insight into trust, usability, and emotional connectedness, which are the factors that heavily influence ongoing use and effectiveness. Mixed-methods evaluations can offer a more holistic picture, identifying both enabling factors and potential unintended consequences.

Examples from high-income and low-resource settings alike demonstrate the feasibility of such research. In Australia, for instance, digital postnatal care trials have shown significant improvements in postpartum follow-up and mental health screening rates. Similar initiatives in Canada and the UK have documented increased digital health literacy, reduced travel costs, and stronger engagement with care providers (Palmer et al., 2019).

Policy, Practice, and the Future of Midwife-Led Innovation

For digital midwifery to reach its full potential, system-level changes are required. These include secure digital infrastructure, policy frameworks that legitimise remote care as standard, not optional practice, and funding models that reimburse midwives for virtual consultations just as they do for in-person visits.

Professional education must also adapt. Training midwives in digital competencies, data interpretation, and online communication is essential. Moreover, midwives must be recognised not only as technology users but also as co-designers, implementers, and evaluators of digital health solutions. This recognition supports workforce sustainability, as midwives feel their expertise is valued in shaping the future of care.

Finally, collaborative research platforms that enable shared learning across geographies are needed. Global communities of practice can accelerate innovation by enabling researchers and clinicians to exchange tools, evaluation findings, and implementation strategies.

References

Evans, C., Donelle, L., & Hume-Loveland, L. (2020). Social support and online postpartum depression forums: A qualitative study using a feminist poststructuralist lens. Journal of Clinical Nursing, 29(17–18), 3340–3350.

Palmer, K., O’Rourke, P., & Lindsay, D. (2019). Telehealth in rural maternity care: A scoping review. Women and Birth, 32(4), 319–326.

Raynes-Greenow, C., Homer, C. S. E., & Wilson, A. (2021). COVID-19 and the transformation of Australian maternity care: Lessons for digital futures. Australian and New Zealand Journal of Obstetrics and Gynaecology, 61(5), 648–653.

Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2016). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, (4), CD004667.