BACKGROUND:
In Switzerland, midwifery education and practice are structured around 26 professional competencies. Opportunities to apply these competencies may vary by work setting, potentially limiting the scope of practice and leading to professional deskilling.

OBJECTIVES:
To evaluate how frequently midwives apply the 26 professional competencies and identify the factors influencing their opportunities to do so across different work settings.

METHODS:
An online questionnaire was disseminated nationally to all practicing midwives. Midwives rated how often they had the opportunity to practice each competency in the past 12 months, on a scale from 0 (never) to 4 (always). Correlational analyses exploring variations between work settings (hospital vs. extra-hospital) were performed using R. Qualitative data from open-ended questions were thematically analyzed to identify perceived barriers and facilitators. Ethical clearance was granted by the relevant ethics committee. Participation was voluntary; anonymity and confidentiality were ensured.

RESULTS:
The overall mean frequency score across the 26 competencies was 2.74 (N=580). Competencies related to integrating evidence-based knowledge (mean 1.81), using validated tools (mean 1.88), and participating in health promotion programs (mean 1.94) were the least frequently practiced. For 16 competencies (62%), hospital-based midwives reported significantly lower mean frequency scores compared to their extra-hospital counterparts (p < 0.05). Reported barriers in hospital settings included institutional constraints, time pressures, and limited autonomy, while self-employed midwives reported challenges in establishing collaborative networks due to the solitary nature of their practice.

CONCLUSIONS:
Midwives' ability to fully apply their competencies varies by work setting, with hospital-based midwives facing more limitations. These constraints may contribute to deskilling and reduced professional satisfaction. Strengthening institutional support, continuing education, and interprofessional and peer professional networks could enhance practice opportunities across work settings.

KEY MESSAGE:
Midwives in Switzerland face barriers to fully practice their competencies, especially in hospitals settings. Observed underpracticed areas require targeted support to preserve skills, autonomy and care quality. Education - competency development 1 (including three-minute presentation competition)