Background Digital transformation in health professions education is often framed as a matter of technology adoption and educator attitudes. However, in low-resource settings, institutional enabling conditions may play a more decisive role in determining whether digital tools can be meaningfully integrated into teaching practice. This study assessed digital teaching readiness in pre-service midwifery institutions in Nigeria and examined how structural capacity shapes the adoption of digital technologies in education.Methods A convergent parallel mixed-methods design was used. Nineteen midwifery training institutions across five geopolitical zones were assessed using a structured institutional checklist administered electronically via REDCap. Qualitative data included 13 in-depth interviews with educators and preceptors, three focus group discussions with 25 students, and 37 teaching observations. A Digital Teaching Readiness Index (DTRI; 0–100) was constructed from five components: student Internet access, computer laboratories/library computers, projector availability, learning management system (LMS) use, and observed ICT use during teaching. Quantitative data were analysed descriptively, and associations between student–educator ratios and DTRI scores were explored using Spearman rank correlation. Qualitative data were analysed thematically.Results Digital infrastructure was limited. Five institutions (26.3%) provided student Internet access, eight (42.1%) had functional computer laboratories/library computers, and one (5.3%) reported LMS use. ICT use was observed in 6 of 37 teaching sessions (16.2%). DTRI scores ranged from 0 to 60: eleven institutions (57.9%) scored < 20, two (10.5%) scored 20–39, and six (31.6%) scored 40–60. Student–educator ratios varied widely (8:1–282:1) and were moderately negatively correlated with DTRI scores (ρ ≈ −0.58). Qualitative findings highlighted unreliable electricity, limited equipment, and funding constraints as key barriers to digital implementation.Conclusions Digital integration in Nigerian midwifery education is constrained less by attitudinal resistance than by institutional capacity limitations. Addressing infrastructure, governance alignment, and educator support is critical for sustainable digital adoption. The DTRI provides a practical benchmarking tool for assessing digital readiness in similar low-resource training environments.