Practice of midwifery competencies in Switzerland: frequency and influencing factors from a national cross-sectional survey with qualitative analysis of open-ended questions

AIM: To assess how frequently midwives apply the 26 professional competencies across different work settings and to identify factors influencing their opportunities to do so. BACKGROUND: In Switzerland, midwifery education and practices are structured around 26 professional competencies. Opportunities to apply these competencies vary by work setting, potentially restricting scope of practice and participating in deskilling. DESIGN: A national cross-sectional survey was conducted between July and October 2024 among practicing midwives in Switzerland. METHODS: Through an online questionnaire, participants rated how often they had the opportunity to practice each competency in the past twelve months, on a scale from 0 (never) to 4 (always). Differences between hospital and community-based settings were analysed using R. Qualitative responses to open-ended questions were thematically analysed to identify perceived barriers. RESULTS: Among 580 respondents, the mean frequency score across all competencies was 2.76/4. Hospital-based midwives reported significantly lower scores for 16 out of 26 competencies (62 %) compared with those in community-based settings (p < 0.05), particularly from the roles of Health promoter [E], Leader [D] and Expert [A]. Barriers in hospital settings included limited autonomy and poor working conditions, such as time constraints and work overload. CONCLUSIONS: Midwives in Switzerland face barriers to practice the full scope of their competencies, especially in hospital settings. In contrast, community-based environments seem to offer greater professional fulfilment. Strengthening institutional support and recognition, continuing education and professional networks are essential to enabling the full scope of midwifery practice and preserving autonomy, skills and care quality.