Digital maternity care in Germany: a cross-sectional web-based survey on midwives’ perceptions

Comprehensive Summary

This single-country observational study looked at how midwives and midwifery students in Germany perceive their current work situation, use of digital tools, and readiness to adopt emerging digital maternity care technologies, using a web-based survey rather than an AI model to characterize needs relevant to participatory design. Researchers analyzed n = 129 fully completed responses derived from a convenience sample of midwives and midwifery students across Germany, collected between May 2025 and the subsequent recruitment period via professional networks and a national midwifery congress. Data consisted of self-reported questionnaire responses covering workload, digital tool use, awareness of electronic records, telemonitoring, and artificial intelligence, as well as self-rated digital competence. The questionnaire was developed through literature review and participatory design principles, piloted with target users, and administered according to CHERRIES guidelines, with all items mandatory to avoid missing data. Analyses were descriptive only, reporting frequencies, means, standard deviations, and 95% confidence intervals, with no inferential testing or predictive modeling performed. The analysis showed substantial perceived strain within maternity care, with 92.2% (119/129) of respondents agreeing that pressure on midwifery and obstetric care in Germany is increasing, while only 24.1% (31/129) reported having sufficient time to care for pregnant individuals, and 47.3% (61/129) expressed a desire to reduce working hours. Digital tool use was widespread, with 87.6% (113/129) reporting professional use of digital tools, most commonly smartphones and commercial messaging services such as WhatsApp, despite 43.4% (56/129) expressing concerns about their appropriateness and data security. Awareness decreased across digital health modalities, from electronic patient records (87.6%) to electronic maternity records (58.9%), telemonitoring (50.4%), and artificial intelligence (49.6%), with actual use remaining low across all certified technologies. Nevertheless, intention-to-use exceeded disagreement for all modalities, including AI (38.8% agreement), and participants rated their digital competence as relatively high (mean 7.09/10), while simultaneously reporting a notable need for additional training. Secondary descriptive findings highlighted a persistent gap between openness to digital innovation and the limited availability or integration of certified digital solutions within the German maternity care system.

Outcomes and Implications

This study suggests that midwives and midwifery students are broadly open to digitally supported care models and highlights a critical implementation gap that readiness and perceived competence at the individual level are not matched by certified, reimbursable, and structurally supported digital solutions. In clinical practice, these results support the careful development of secure, midwife-centered digital maternity care platforms that can replace uncertified workarounds, improve continuity of care, and potentially alleviate system strain without undermining the relational foundations of midwifery practice. The study indicates that successful translation will depend less on changing individual attitudes and more on organizational, regulatory, and infrastructural alignment. As an initial needs assessment within a participatory design framework, these findings provide a necessary empirical foundation for co-developing, piloting, and ultimately evaluating digitally supported maternity care models that are acceptable, ethical, and feasible within real-world clinical settings.