Health Tech Trends, Interview

Feature: the role of the digital midwife, Hermione Jackson and Sarah Lumley share their experiences

“Digitising our maternity services is transforming the way we work,” said Misbah Mahmood, Lead Digital Project Midwife at Leeds Teaching Hospitals NHS Trust. “Digital midwives are leading the change.”

In March 2021, the Royal College of Midwives launched a positioning statement calling for a Digital Midwife to be included in every maternity service across the country, and NHSX announced that it was recruiting a Digital Midwife to support strategy at regional and national level, to provide leadership, coordination and evaluation across digital maternity work streams. Following that, June 2021 saw the NHS plan an additional £52 million into digitising maternity services, and 128 successful bids were announced in March 2022 as part of the Digital Maternity Fund.

With midwifery in a state of change and digital transformation at the heart of that, HTN spoke to two Digital Midwives to find out more about what the role entails and what it means for the future of midwifery.

In this feature we speak with Hermione Jackson, Digital Midwife at King’s College Hospital NHS Foundation Trust and Sarah Lumley, Specialist Digital Midwife at Bedfordshire Hospitals NHS Foundation Trust.

Digital Midwives: the basics

“It’s about putting the right technology in the hands of midwives so that they have better access to the information they need to provide individualised care to women and birth people, as well as reducing the administrative burden on midwives,” said Hermione Jackson, Digital Midwife at King’s College Hospital. “This means they can spend more time providing that clinical care and less time documenting and sharing information with other health professionals involved in the women’s care.”

Sarah Lumley, Specialist Digital Midwife at Bedford Hospital Site, has been in the role for 8 years. Sarah described the role as “a subject matter expert and recognised digital leader.” As part of the Maternity Transformation Programme, Digital Midwives “use their clinical expertise to streamline [traditional midwifery] processes and provide digital solutions for safer, more personalised care.”

Sarah also discussed how data management plays a significant role in digital midwifery; “trusts have to report into the Maternity Services Data Set (MSDS), which feeds into part of CNST compliance. We have to ensure that the data is complete and accurate and that any rejections from the MSDS are rectified. This data is also reported regionally and nationally in safety and performance dashboards, and is used in audits and to evidence risk assessments.”

“On a practical level, day-to-day, Digital Midwives work with clinical Midwives to make sure that the system is being used properly, and to identify where changes might be needed,” said Hermione. “We liaise with system suppliers to make those changes, and we project manage the implementation of new digital technologies as they become available. We support service users to ensure that the technology is working well for them, and that their experience of Midwives using that technology is improving the care they receive.”

The role of technology

The technology used by Digital Midwives “depends on the digital maturity of the trust,” said Sarah. “Each trust has a Maternity Information System (MIS) which should capture data from a woman or birthing person at booking, their antenatal journey, their birth and the postnatal period right up until discharge (end-to-end). Historically this journey was recorded in handheld maternity notes and the MIS just captured birth and postnatal discharge data.  In some trusts this is still the case.  Other trusts have an end-to-end MIS providing an Electronic Patient Record (EPR) where data is captured electronically rather than on paper.”

“The role isn’t just centred around maternity information systems, however,” Hermione pointed out. “It will encompass all types of digital technology we might use, such as central monitoring systems, electronic diary management systems, and digital access for women to view their own maternity records. It also might encompass supporting Midwives to use basic technology within their practice such as emails or information-sharing tools. Maternity is one of the areas where we are going to see machine learning and artificial intelligence support in practice. We already have digital algorithms to help support decision-making and ensure that Midwives have the information they need to support women on their maternity journey.”

“Digital records enable care to be shared more easily between healthcare providers in a safe, secure way,” said Sarah. “It also means that the record is carried with the woman or birthing person enabling access to care anywhere, with a full history.  This improves safety and continuity of care.”

What do Digital Midwives need to succeed?

Considering what Digital Midwives need to support them in their roles, Hermione said, “They need recognition and leadership support so that they can practise effectively. This means they need to be employed at a level within the organisation where they are able to make changes to the service and implement new technologies as appropriate. They need a seat at the table so their voice can travel up within the organisation to board level, so that maternity service needs are well-represented within the trust.”

“Awareness and promotion is vital,” added Sarah. “I regularly have conversations assuring people that I am not a robot and I do not facilitate birth via a laptop.  These light-hearted questions are always a good way to promote the role and actually explain the benefits. Having a supportive management team behind you is essential. They view you as the digital specialist and enable your involvement in digital strategy and transformation.”

Hermione agreed: “The Digital Midwife role is often quite a lonely job – most trusts only have one Digital Midwife within their organisation, so leadership support and networking is vital. We’ve seen fantastic results from the network of Digital Midwives offering peer support to each other across the country via a WhatsApp chat, allowing the Midwives to link with others doing similar projects.”

Peer support is also important to Sarah. “We are fondly referred to as the #DMarmy by the National Lead Digital Midwife Jules Gudgeon,” she said. “With Jules at the helm we have managed to promote the role and the Digital Midwives Expert Reference Group (DMERG) where digital maternity specialists come together to learn from and support each other. There are many exciting national digital projects on the horizon.  We are building a network of digital maternity specialists that are finally getting the recognition we deserve.”

“We also need the funding to support basic technology required by maternity services,” said Hermione. “Maternity services are often viewed as separate to digital plans for the wider hospital, and often seem as quite a difficult area to address due to the complexity of inpatient/outpatient services as well as 24-hour labour ward care. We’ve often seen Digital Midwives reporting that they are held back or hindered in their ambitions because the funding available is diverted elsewhere rather than making it through to maternity services.”

Looking to the future

“Last year there was a second national Digital Maturity Assessment (DMA) to assess each trust’s use of digital solutions,” Sarah shared, “and it highlighted a big discrepancy between trusts.  This resulted in the Unified Tech Fund (UTF) where £52 million of funds were released for digital uplift. Following a successful bid, my trust secured £208,000 which has enabled us to purchase hardware to push our digital journey forward.  The hope for the future is that more funds will be released to assist further.”

Looking ahead, Hermione shared her thoughts on how information-sharing can be improved. “Technology is still used in silos within organisations,” she said, “or even within the maternity departments. Standards have been set to start the building blocks for sharing maternity records more easily between hospitals and with primary care services, but this isn’t yet happening smoothly and efficiently. This means that some information-sharing remains, and often women are required to re-tell their story to each new health professional they meet. However, there has been significant progress with the standards for information-sharing being established and maternity services are now all working towards implementing these standards.”

Digital input from the patient perspective 

“On a personal level, I found the digital technology available in the trust where I received my maternity care really made my experience smoother,” shared Hermione. “I have an app where I can view my records, appointments and relevant health information to support my decision making. I can also upload photos, keep a journal and write my birth plan in the app. The midwives can view my birth plan from their side of the electronic record. When I call my midwives with questions or concerns they are able to view my record and provide relevant personalised advice with my health record in front of them, which also allows them to update the record remotely when required. I didn’t need to see my GP during my pregnancy but I was aware there’s a feature in the app to share my record with my GP if I want to – but I have control of who I share it with.”

Many thanks to Hermione and Sarah for sharing their thoughts and experiences.