Exploring Health Technology in Community Midwifery Care: An Insightful Interview Study
Published: March 14, 2025
Authors: Holly Edmundson, Margaret Glogowska, Gail Hayward, & Jude Mossop
Abstract
Background: New, portable health technologies offer potential solutions to challenges in modern maternity care. However, there’s a gap in understanding their current utilization, existing problems, and unmet needs.
Purpose: To gain a deeper understanding of how health technology is used within community midwifery services in the UK.
Methods: Semi-structured interviews were conducted with midwives currently or recently working in community settings, recruited via social media. The gathered data was transcribed and thematically analyzed.
Results: Thirteen midwives were interviewed between October 2021 and March 2022. The main themes that emerged include: (1) Problems with current equipment stemming from issues faced when working remotely, accuracy concerns, and the midwives’ perspectives on the experiences of those using the service. (2) Equipment challenges within the UK National Health Service (NHS), namely the lack of access to suitable equipment and limited control over how to use the equipment available. (3) Areas of unmet needs.
Conclusion: This study highlighted several unmet needs for community midwives that require further investigation. Furthermore, it is important to improve the quality and availability of the technologies and other crucial equipment that is already widely used by midwives. Midwives expressed interest in technologies that support decision-making, reduce hospital visits for their patients, improve their workload, and reduce medical interventions. However, there were also expressed fears that technology could undermine the experience and wisdom of midwives. Proper training and support should be provided when introducing new technologies to ensure that midwives aren’t resistant.
Introduction
The formalization of midwifery training in the UK occurred with the introduction of the Midwives Act in 1902, which included guidance on the necessary equipment for midwives. Much of the equipment used today, such as handheld fetal dopplers and urinalysis sticks, was first introduced in the mid-20th century. Despite advancements in portable health technology, sometimes referred to as point-of-care tests (POCTs), which enable hospital-level diagnostics in the home and community, updating midwives’ equipment has progressed slowly.
The NHS maternity services in the UK are experiencing significant pressure. Recent independent inquiries and surveillance programs have highlighted failings in maternity services that require attention. This is made more difficult by severe staff shortages and increasingly complex caseloads. Introducing new health technologies in community midwifery settings has the potential to enhance improvement strategies. For example, such efforts may reduce pressure in obstetric units and increase healthcare accessibility for women. Reviewing midwives’ current experiences is critical to stimulating the proper development and use of medical technologies for community maternity services.
This study aims to uncover midwives’ knowledge, experiences, and perceptions of health technologies, including their views on unmet needs.
Methods
This study utilizes a qualitative approach to examine the lived experiences of UK community midwives regarding health technologies. This approach aims to provide authentic insight into the equipment challenges midwives face by emphasizing individual experiences. Qualitative research captures and explores people’s experiences and perceptions. Therefore, qualitative semi-structured interviews were employed to investigate midwives’ knowledge, experiences, and perceptions of health technologies used in community maternity care. This method allows researchers to cover the topics of interest to them but also gives participants the opportunity to voice issues of important personal and professional significance.
Sampling and Recruitment
Midwives with current or prior experience in community-based settings within the UK were invited to participate in this study. The study was promoted on social media platforms such as Facebook groups like ‘Maternity and Midwifery Forum,’ ‘Continuity Matters,’ and ‘Midwifery Study Days & Conferences,’ as well as on Twitter. These posts contained links to a study webpage, which included the Patient Information Leaflet (PIL) and contact details for interested individuals.
All respondents who met the inclusion criteria were invited to participate in an interview. The research team discussed and agreed when a sufficient explanation of the emerging themes had been achieved, and when enough information had emerged, they ceased interviewing.
Interviews
Approximately 30-minute qualitative semi-structured individual interviews were conducted by telephone. Except for one interview conducted by JM, all interviews were conducted by the primary researcher, HE. Prior to the interview, informed verbal consent was obtained. A topic guide was used. The topics were taken from existing literature and issues from other studies looking at clinicians’ views on POCTs. To adapt the topic guide for a midwifery audience, informal feedback was obtained from community midwives, with amendments to the questions as the interviews progressed.
The interviews were recorded using a digital audio recorder and transcribed verbatim by a professional transcriber. Field notes were taken by the primary researcher during and after the interviews.
Analysis
The transcripts were checked for accuracy and anonymised before being uploaded to a specialist software programme (NVivo V.1) to assist in organizing and analyzing the data. A grounded-theory approach was used to perform a thematic analysis of the interviews. Grounded Theory is a qualitative methodology that guides systematic data collection and data analysis. This approach makes the iterative generation of information possible based on the data through constant comparison. It is a particularly useful approach when exploring new or under-researched topics. The data was coded to group it. The codes were grouped and compared to create categories. The development of the broad themes was supported by single-sheet brainstorming. Transparency and dependability were ensured by creating an audit trail from the raw data to the themes and obtaining agreement on the analysis from the research team.
Researcher Characteristics and Reflexivity
The primary researcher was HE (MSc, female), a practicing community midwife and an early-career researcher. JM (BA (Hons), female) is a Senior Research Midwife with a background in qualitative research. Throughout the process of data collection and analysis, ME received support from MG (PhD, female), a senior qualitative researcher. The only information the interviewed midwives were given about HE and JM were their current job titles. One of the interviewed midwives and HE knew each other because they worked at the same NHS Trust but in different teams. The participants had minimal contact with HE prior to the interviews, only to schedule the interviews. Interviewers who were midwives facilitated smooth conversation and sometimes the interviewees asked HE about her personal experiences. When this happened, HE explained that these could be discussed upon completion of the interview.
Findings
Thirteen interviews were conducted between October 2021 and March 2022. Two other midwives contacted the research team about participation. One could not be interviewed due to unavailability, and the other failed to meet the eligibility criteria.
Participant Characteristics
All participants were midwives working in community settings within the National Health Service (NHS) or had done so in the 12 months preceding the interview.
Health Technology Used by the Midwives Interviewed
The midwives detailed using health technology for several tasks, including assisting in clinical decision-making, supporting public health initiatives, and providing reassurance. Table 2 shows the health technologies used in the community setting by at least one of the midwives interviewed in this study. Few in vitro diagnostic (IVD) POCTs (equipment that quickly analyzes samples taken from the human body – immediately, on-site) are currently used in community midwifery practice. The interviewed midwives collected samples but then sent them to a hospital laboratory for analysis. Similarly, ultrasound scanning in the midwives’ NHS Trusts was performed exclusively in a hospital and not by community midwives.
Themes and Subthemes
The research team identified the following main themes and subthemes:
1) Problems with Current Equipment: a) Issues in the context of remote working b) Concerns regarding accuracy c) Midwives’ perceptions of service user experiences
2) Equipment Challenges Working within the NHS: a) Lack of availability of appropriate equipment b) Lack of autonomy in how to utilize equipment
3) Areas of Unmet Needs
Theme One: Problems with Current Equipment
The interviewed midwives were generally satisfied with the health technology and equipment available to them. However, several recurrent issues emerged. Notably, despite describing serious challenges, midwives often framed these issues as mere inconveniences—suggesting a level of normalisation and acceptance of suboptimal conditions as an inherent part of their role.
1a. Issues in the Context of Remote Working
Most of the midwives interviewed worked from a central base, such as a midwifery-led unit, but would provide most of their care in women’s homes or from GP surgeries and community spaces. They transported necessary equipment in their cars, so they wanted items to be portable and sturdy. Many midwives highlighted handheld fetal doppler devices as being too fragile. Several described doing ‘DIY repairs’ while waiting for a new device.
“We also have a doppler, which is just about giving up the ghost because they’re not the most robust things in the world. It’s being held together with tape until I can get a new one.” – Midwife B.
Almost all of the interviewed midwives reported problems with thermometers, including axillary, tympanic, and single-use models. Accuracy was considered unreliable, and there were concerns that this was exacerbated when they had to store their equipment in imperfect conditions, such as their cars.
“We’re not supplied with reliable equipment in the community… I think many of us have bought our own thermometers because the ones that we’ve been issued with are rubbish… We were issued some time ago with thermometers that you put under the arm and they take about 3 min to read… you can get them in the pound shop and to be honest they’re just as good. We sometimes have stocks of the tempedots [single use thermometers] and they’re okay until you’ve had them in the car in warm weather.” – Midwife M.
Many midwives believed that the equipment provided was heavy or bulky, making it impractical or potentially dangerous. Baby weighing scales, including a tray for the baby, were highlighted as a particular problem.
“If there’s a way of making stuff, I don’t know, smaller or lighter or more compact or easier to transport? So it’s easier on midwives’ backs, because our backs go.” – Midwife A.
1b. Concerns Regarding Accuracy
Several midwives had experiences with packs of urinalysis sticks that were faulty or degraded. One midwife felt that the test took too long and suggested that this probably resulted in some underdiagnosis.
“You know on the odd occasion you’ll get a dud set [of urinalysis sticks] where literally everyone has protein, and then you realize that you’ve got a dud pack and you just change the pack…. Or if someone tells me they’ve got good signs of a UTI [urinary tract infection] and it’s completely clear, I’ll just try my other packet just in case.” – Midwife I.
Many midwives discussed POCTs for diagnosing pre-labor rupture of membranes. These tests, which come in various forms, including swab tests and sanitary pads, detect amniotic fluid. These were not used by all the midwives, and several noted that they were introduced and then removed due to accuracy concerns (and, in one instance, cost). The midwives generally felt that these would be helpful as long as the results could be trusted.
“We did occasionally use amniopads… They’re sanitary towels that change colour in the presence of amniotic fluid. But, they don’t seem to be very reliable. I know of some women who had definitely SROM’d [spontaneous rupture of membranes], but the pad didn’t change colour. We didn’t get them back again and I think that was why, because they weren’t very reliable.” – Midwife C.
1c. Midwives’ Perceptions of Service User Experiences
The midwives were concerned with the women in their care’s experiences, especially since childbirth and pregnancy are times of elevated psychological vulnerability and physical demand. They felt that some of their equipment had not been designed with this in mind.
“The [adult thermometer] reads under the tongue. Which I think is horrifically invasive, especially when someone is in labor. Like just a really unpleasant thing. They take ages, they take well over a minute. And when you’re in labor, in particular, that’s really vile.” – Midwife D.
Some interviewed midwives recognized that the used equipment could contribute to patients’ negative feelings about increased BMI and wished to avoid it.
“Having to change the [blood pressure] cuff sizes for women with a larger BMI… I’m very aware that women with a larger BMI have clocked that we do it and can, you can see the instant awkward look. So that’s a shame… From that perspective it would be nice if there was something, you know, a generic one size fits all, if possible.” – Midwife A.
One midwife, who cared for many non-English-speaking women, felt her carbon monoxide (CO) monitor was confusing for her patients because the instructions were complex to explain, even with an interpreter. This monitoring helps assess a woman’s CO exposure and supports referrals to smoking cessation services, and provides encouragement to those already quitting smoking.
Theme Two: Equipment Challenges Working within the NHS
2a. Lack of Availability of Appropriate Equipment
All participants reported little or no involvement in any decisions regarding equipment purchasing, the introduction of new health technologies, or their Trust’s operating procedures and policies regarding equipment use. There was a consensus that several issues with equipment were caused by Trusts generally choosing lower-priced options, with little consideration given to the staff using it.
“It’s really hard to influence your purchasing, isn’t it? Because it’s all done on a mass level these days and they’re influenced by price.” – Midwife D.
Many interviewed midwives reported buying their own equipment because they weren’t supplied with anything they felt they needed or because they felt the kit items did not meet an acceptable standard. Examples included ophthalmoscopes, stethoscopes, thermometers, and oxygen saturation monitors.
“I bought my own stethoscope because the ones that we were provided with were pretty cheap and hurt my ears.” – Midwife C.
Several reported frustrations at sharing equipment with colleagues, such as blood pressure cuffs and baby weighing scales. The midwives all used aneroid devices, not digital devices, for blood pressure monitoring. Some were interested in using digital monitors, but either they were unavailable or midwives were discouraged because of accuracy concerns. Some midwives felt aneroid devices were faster to use, while others felt access to a digital device would free up time to complete another task.
“I have been in GP surgeries where there is the electronic [BP monitor] to hand. And then I find that if you use that, you almost inevitably go ‘That’s a bit high, let me actually check properly.’“ – Midwife K.
Two devices that many midwives were expected to use often but that were not easily available were transcutaneous bilirubinometers (TCBs) (used to monitor newborn jaundice) and oxygen saturation monitors for babies (used during routine and emergency assessments for respiratory or cardiac complications). The midwives were sensitive to the fact that these items are expensive but still found it challenging not to have easy access to them. They described considerable time spent traveling, collecting, and returning the devices between appointments.
“You could be travelling thirty miles to the hospital to get a TCB… it’s very frustrating. But the problem is, they’re four and a half thousand pounds each. We have just bought a couple more because someone donated money. In an ideal world, you’d have more. Each midwife would have one… Because there’s a lot of time wasted going looking around for one of these monitors. We do oxygen saturations on a baby as well. We have to go to the hospital to get that [monitor], because there’s very few of those… which is again time-consuming as a community midwife, to go backwards and forwards all the time.” – Midwife H.
2b. Lacking Autonomy in How to Utilize Equipment
In general, the midwives felt that all the tests they were expected to perform were appropriate and beneficial to the care they provided. One exception was CO monitoring. At the time of the interviews, and still now, Trusts were instructed to share compliance data as part of the Maternity Incentive Scheme. While most interviewed midwives were in favor of the availability of this test to support smoking cessation, several wanted autonomy to use their equipment as they saw fit, as opposed to following a prescriptive, target-driven protocol.
“So people weren’t being screened [for CO]. But then well, the email [from senior leadership] said something along the lines of, “You’re not doing it at the 36 week appointments, so we’re going to make you do it at every appointment.” I don’t think that’s evidence-based. I think that’s sort of “you naughty midwives.” – Midwife F.
Theme Three: Areas of Unmet Needs
When questioned about areas of unmet needs, many midwives were hesitant about adding new tests, fearing it might overcomplicate care or deskill them or the students they supported in practice. Costs to their Trusts were also a concern.
“It’s a fine balance between sort of introducing technology, because then does that make us more just obstetric nurses? Rather than the skills that you have, the skills of palpation. Obviously you do question yourself at times… “is it breech? Is it something else?” But, that’s just wisdom you wouldn’t want to lose and technology doesn’t take into account everything.” – Midwife E. “Midwives I know like to know their equipment and they’re a bit funny when it comes to change at the best of times. Also, the financial implications for the Trust securing the equipment, in my eyes would be a nightmare.” – Midwife A.
Several midwives expressed unease regarding introducing equipment into the community that they were used to seeing in the hospital. There was uncertainty about training logistics and how to diagnose and manage pregnancy complications without an obstetrician’s input. Generally, when participants reported wanting more health technology, they described devices they knew were already on the market and often used by community midwives in other Trusts. These included transcutaneous bilirubinometers, serum bilirubin measurement equipment, oxygen saturation monitors (adult and newborn), tests for amniotic fluid, and CTGs.
Two POCTs not currently used by any of those interviewed which the midwives felt would be useful and practical to introduce to a community setting. These were portable ultrasound scanners for presentation scans and IVD POCTs for diagnosing anemia, preeclampsia, and infections such as Group B Streptococcus (GBS) and UTIs.
When asked why they would like to see new technologies introduced, the midwives gave four main reasons:
1) To Support Decision Making. Some midwives felt their assessments lacked the same components and, therefore, completeness of a hospital assessment. Where relevant portable technology existed, they felt it should be incorporated.
“I’ve worked with MSWs [maternity support workers] and I can see protein [showing as present on the urinalysis dipstick], they can’t or vice versa, so actually, it it’s very subjective… I think we should use a urinalysis machine to analyse it rather than our eyes. That could be a really useful tool.” – Midwife K. “A little pulse oximeter would be really handy to have in the kit bag… We do have to calculate the early warning score in the home, and obviously oxygen saturation [monitors] would help with that.” – Midwife L.
2) To Reduce the Number of Hospital Visits for Patients. This was important to the midwives as they felt that women often struggled with getting to the hospital or would prefer to avoid it for psychological reasons.
“In the main hospital, they will do PROM [pre-labor rupture of membranes] testing but for some reason at the midwife-led unit we don’t have it… We then have to send them [the women] all the way up to the hospital. The same with women who’ve a planned home birth. They don’t want to have to come into hospital.” – Midwife J.
3) To Improve Workload. For example, not having to spend time (often outside of normal working hours) transporting samples to a hospital or waiting for results to arrange appropriate treatment.
“I’d like better access to testing. Just the whole thing about having to keep going back to the hospital with everything, that’s my big bugbear… I would like to be able to get an instant result on a swab for Group B Strep. That would be really useful. The fact that they take such a long time to come back. An MSU [mid stream urine culture] can take 5 days before I get the result, or a swab, that is ridiculous to me.” – Midwife M.
4) To Reduce the Overmedicalisation of Care. The midwives felt that once women are in the hospital setting, they might inadvertently be screened for other potential risks, leading to anxieties around birth and a cascade of interventions.
“I’d like one of those little handheld ultrasound machines, just so I can check if babies are breech. I don’t want to get involved in size… But I’d just like, you know those ones that you, you’re like ‘I can’t be 100% sure’ and you send them for a scan at 36 weeks and then something else gets picked up that’s a load of old rubbish.” – Midwife D.
Discussion
This is the first qualitative study where UK-based community midwives were asked about the health technology they use to support their roles. This study aimed to understand more about what midwives think of their existing healthcare technologies and what they would like to see in the future. This included any diagnoses they could not currently make in the community but felt would benefit their patients or themselves. The research captured practical issues with equipment and the midwives’ emotional and professional responses within the NHS context.
Summary of Key Findings
Midwives generally feel that they are meeting the needs of the women in their care with the current POCTs and equipment. The findings reveal the challenges faced by community midwives working within the NHS, including a lack of involvement in purchasing decisions, frustrations about having to share or buy their own equipment, and the desire for autonomy in using equipment. The perceived tendency for Trusts to opt for lower-priced options was criticized for failing to consider staff needs. A recently published qualitative study investigating UK community midwives’ experiences providing postnatal care corroborates the finding that midwives were dissatisfied with the limited availability of resources. The midwives described spending considerable working hours accessing shared equipment. This is concerning, as work frustrations have been linked to high levels of work-related burnout, depression, and anxiety observed in UK midwives.
The midwives had a woman-centered approach to their practice and considered ways equipment might negatively impact how women felt. They wanted a flexible, individualized approach to equipment usage as opposed to strict, target-driven protocols. This tension was particularly evident in discussions around CO monitoring. Midwives discussed the need for blood pressure cuffs of various sizes and were concerned about how this might make women feel. Marginalized groups, including those with a raised BMI, can find accessing healthcare stressful and might avoid help if they feel shame about their size.
Midwives have some interest in introducing new equipment, particularly where it may support their decision-making, improve their workload, and reduce the number of women needing to go to the hospital, which can be logistically challenging and lead to a cascade of unnecessary medicalisation. At the same time, they don’t want to see community-based midwifery units turned into ‘mini’ obstetric units.
Conclusion
This study showed several areas of unmet needs for community midwives that should be investigated; however, it is more pressing to improve quality and availability of existing technologies. Based on the results of this study, the following criteria should be considered when designing or procuring diagnostic technologies for use in maternity care:
- Will this product improve clinical decision-making; reduce hospital-based care; or support clinician time management?
- Has this product been designed specifically for a maternity population? Could the use of this product cause any physical or psychological harm, or disturb physiological labor?
- Is the quality sufficient to meet the demands of transportation, changes in temperature and frequent use in various environments?
- Is this product at a price point that ensures the midwifery workforce can be adequately equipped?
- Does this product come with sufficient evidence of accuracy and reliability within the maternity population to ensure that midwives trust the results given? Is there evidence of cost-effectiveness?
- Are there evidence-based guidelines to support midwives in their clinical decision-making when using this product?
