The rapid advancement of information and communication technology has greatly facilitated access to information across various sectors, including healthcare services. This digital transformation demands enhanced knowledge and skills among healthcare providers, particularly in comprehensive midwifery care. However, midwives in rural areas face numerous challenges such as limited resources, cultural factors, knowledge disparities, geographic conditions, and technological adoption. This research aims to evaluate the impact of AI utilization on midwives’ knowledge and behavior to optimize the implementation of healthcare services in accordance with Delima Midwife Service standards in rural settings. The analysis encompasses competencies, characteristics, information systems, learning processes, and health examinations conducted by midwives in adopting AI. The research methodology employs a cross-sectional approach involving 413 rural midwives selected proportionally. Results from Partial Least Squares Structural Equation Modeling indicate that all reflective evaluation variables meet the required criteria. Fornell-Larcker criterion demonstrates that the square root of AVE is greater than other variables. The primary findings reveal that information systems (0.029) and midwives’ competencies (0.033) significantly influence AI utilization. Furthermore, midwives’ competencies (0.002), characteristics (0.031), and AI utilization (0.011) also significantly impact midwives’ knowledge and behavior. Midwives’ characteristics also significantly affect their competencies (0.000), while midwives’ learning influences health examinations (0.000). Midwives’ knowledge and behavior affect the transformation of healthcare services in rural midwifery (0.022). The model fit results in a value of 0.097, empirically supporting the explanation of relationships among variables in the model and meeting the established linearity test.