Why digital maternal care should be built around midwives

A lot of digital health starts with a question about technology. What can an app track? What could an algorithm predict? For maternal and reproductive health, we think there is a better first question. Who already provides the care that makes the most difference, and how can technology help them reach more women?

For much of the world, the answer is midwives. The evidence for their impact is strong, the shortage of them is large, and both facts should shape how digital maternal care is designed.

What the evidence says about midwives

The International Confederation of Midwives defines the midwife as a professional who works in partnership with women to give the support, care and advice they need during pregnancy, labour and the postnatal period. The definition also gives midwives an important role in health counselling and education, for women and within families and communities, and notes that they may practise in any setting, including the home, the community, hospitals and clinics.

That breadth matters. Midwifery is clinical care, and it is also education, continuity and relationship. Those are exactly the things digital tools are often asked to provide.

The potential impact is large. A modelling study in The Lancet Global Health looked at 88 low and middle-income countries. It estimated that a substantial increase in coverage of interventions that midwives can deliver could avert 41% of maternal deaths, 39% of neonatal deaths and 26% of stillbirths, about 2.2 million deaths averted each year by 2035. Universal coverage of those interventions would allow an estimated 4.3 million lives to be saved each year.

The authors were careful about the conditions. To realise this potential, midwives need skills and competencies in line with ICM recommendations, they need to be part of a team of sufficient size and skill, and they need to work in an enabling environment. Those conditions are the part digital tools can either support or make harder.

The shortage is the real constraint

UNFPA's State of the World's Midwifery 2021 report estimates a global shortage of 900,000 midwives. On current trends, it projects that the gap will still be around 750,000 in 2030.

That shortage sits behind a grim number. WHO estimates that about 260,000 women died during and following pregnancy and childbirth in 2023. It also notes that most maternal deaths are preventable, because the ways to prevent or manage complications are well known.

No app trains a midwife or creates a new post. But a shortage means that every hour a midwife has is valuable. Digital tools can either protect that time or eat into it.

Extending reach without adding burden

WHO's first guideline on digital health interventions, published in 2019, gives a balanced picture. It describes telemedicine as a valuable complement to face-to-face care that cannot replace it entirely. It also stresses that health workers need adequate training and tools that are simple to use if digital approaches are to work.

For product teams, that translates into a few practical commitments.

• Design for both sides of the consultation. A midwife needs to see relevant context quickly, without hunting through screens. A woman needs to know what to prepare, what to expect and what happens afterwards.
• Give conversations structure. A clear format helps a remote consultation stay focused on what matters, and makes it easier to record what was discussed.
• Make follow-up part of the design. Care does not end when a call does. A simple, time-limited way to ask a follow-up question can matter as much as the first conversation.
• Respect professional boundaries. Some questions need an in-person examination or a referral. The product should make that easy to say and easy to act on, not treat it as a failure.
• Let education do some of the work. Good educational content answers common questions before they reach a consultation, so that time with a midwife goes to the questions that need one.

Designing with midwives, not for them

The most reliable way to get these details right is to involve midwives in the design itself. They know which questions women ask most often, which worries come up at which stage, and where existing tools add administrative work. They can also tell when a feature would cross a clinical line.

Midwives also bring a view of the whole pathway that a product team rarely has. A woman's questions do not arrive neatly sorted into antenatal, labour and postnatal stages, and a midwife knows how worries carry over from one stage to the next. A product built with that knowledge can connect its tracking, its education and its consultations in a way that matches how care unfolds, instead of presenting them as separate tools that happen to share an app.

That involvement should not end at launch. Professional input on content, on safety and on how consultations are structured needs to continue as a product changes. A midwife reviewing an educational article before it is published is a small step that protects both the women who read it and the trust the product depends on.

Where Obaa+ fits

Obaa+, the women's health app Luna is building, is designed around this idea. Alongside menstrual and pregnancy tracking and an Edu Hub of articles and short videos, it offers a pathway to structured consultations with certified midwives. It also keeps a consultation history and offers time-limited follow-up where supported.

Obaa+ is still in development. Our aim is simple to state and demanding to deliver. When a woman has a question that tracking and education cannot answer, she should be able to reach a certified midwife through a consultation that respects her time and theirs.

If you would like to follow that work, you can join the Obaa+ waitlist and hear from us as it develops.