How midwives use remote monitoring to spot patterns between visits

The standard antenatal visit schedule was designed with population-level risk in mind. For a low-risk pregnancy, four to five appointments in the second trimester and several more in the third provides adequate clinical contact for the majority of patients. This is evidence-based and appropriate. It is also, for any individual patient, a schedule with gaps in it.

Midwives increasingly ask whether they can see more of what happens between appointments without greatly increasing clinical contact time. Remote monitoring and daily patient logging offer one possible answer. We have been exploring that approach on a small scale over the past several months.

This article reflects observations from a 12-patient pilot with community midwives in the Greater Manchester area. It is a small sample, so we make no statistical claims. It did reveal recurring patterns in how midwives interpreted incoming data and used it, and how this altered clinical conversations.

Note: this article is for midwives and providers and shares observations from our early pilot. It is not medical advice for patients. Parents with questions about their care should speak directly with their midwife.

What the pilot involved

Twelve patients, enrolled between 16 weeks and 34 weeks of pregnancy, logged daily check-ins through Materai. These covered foetal movement, symptoms, and blood pressure readings for those with home monitors. Attending midwives could view each patient's daily summary through a simple alert dashboard.

The alert layer was deliberately conservative. Midwives were notified when logged data suggested a pattern worth reviewing, rather than for every daily entry. The aim was to add a signal layer, not replace clinical judgement with algorithmic triage.

Midwives were asked informally whether the incoming data changed how they managed patients between appointments. Three midwives shared observations over three months. The account below comes from those conversations, not a formal clinical study.

What changed for midwives

The clearest recurring observation concerned appointment conversations. One midwife put it this way: a patient might previously arrive saying, "I've had a few headaches." That is difficult to assess. A record showing five headaches across nine days, including two marked severe, gives a very different clinical picture and makes the conversation more focused.

This move from retrospective impression to a documented timeline came up repeatedly. Patients may understate symptoms in clinic because they have become used to them, do not want to seem anxious, or cannot accurately recall what happened three weeks earlier. Daily logging captures symptoms when they occur, before the retrospective rationalisation that can happen between visits.

One midwife also found that blood pressure trends became visible. Readings of 118/74, then 122/78, then 127/82 at successive appointments might not prompt concern on their own. Seeing daily readings over six weeks showed a consistent upward trend, so she increased monitoring before readings reached the threshold that would normally prompt action. Better data supported early, proactive clinical judgement.

Where the friction lay

The process did not always work as intended. Engagement with daily logging varied. Several patients logged consistently for the first two weeks, then less often. Some found the morning check-in easy, while others forgot the added task. Engagement was usually highest in the third trimester, when being closer to delivery seemed to increase motivation to monitor closely.

Midwives responded well to the alert dashboard, but workload remains a real concern. Even a conservative alert layer creates notifications that need attention. Five patient flags in a morning can help a midwife with a full caseload; fifty cannot. Finding the right alert sensitivity remains an ongoing design challenge, and we are still learning where the thresholds should sit.

Midwives also saw cases where logged data increased anxiety rather than easing it. A foetal movement count lower than the previous day, but without clinical significance, could worry a patient comparing each day's record. This is a real tension in consumer-facing monitoring: information useful to a trained clinician can be harder for a parent to interpret without support.

What this means for building Materai

These observations informed several product decisions. Alert logic is deliberately asymmetric: parents receive reassurance when patterns are stable and clear flags when something needs attention, but not raw numerical comparisons that can be misread without clinical training. The provider dashboard offers greater detail because midwives are trained to put it in context.

We are also focusing on appointment preparation. Midwives in the pilot valued a condensed summary of the previous four weeks at the start of an appointment. It shifts the opening from "how have you been?" which depends on memory, to a structured review of a specific record. That small change creates more clinical value from the same appointment time.

A 12-patient pilot cannot provide much statistical confidence. It offers an early indication of whether the approach makes sense and produces useful data for clinicians. Both appear to be true, which is encouraging. However, we have a long way to go before making claims about clinical outcomes or performance at scale.

The honest picture of where we are

We are a small team building something we believe addresses a real structural gap in antenatal care. The gap is not appointment quality. UK antenatal care is genuinely good. It lies between appointments, during the 29 or 42 days when patients are largely self-monitoring with varying tools and guidance.

Remote daily monitoring is not new. Telemonitoring in hypertensive pregnancy has been researched actively for several years. Our focus is making daily logging light enough for patients to keep doing, and making the resulting data useful enough for clinicians to use. Neither is simple, and a 12-patient pilot is only a beginning.

Midwives and practice managers interested in how this could work in their setting are welcome to speak with us. We are not yet scaling broadly. We are seeking a small number of clinical partners to help refine the approach before we do.