INTRODUCTION: Not all midwives in the Netherlands are independent practitioners. One in 4 midwives registered to practice is employed in the hospital setting, where 67% of all births occur. There has not yet been an in-depth examination of hospital-based midwives' practice in the Netherlands, in the context of care in a higher-risk environment. The primary aims of this study were to describe the diversity and scope of practice of hospital-based midwives in the Netherlands.METHODS: This was an online survey of all hospitals throughout the Netherlands with labor/birthing rooms and employing hospital-based midwives. The survey covered 5 topic areas: demographic/organizational details, duties, responsibilities, experience/additional qualifications, and how the midwife functioned within the multidisciplinary hospital team. Descriptive statistics are provided.RESULTS: A total of 59 secondary and tertiary level hospitals from a possible total of 98 were included for analysis (60% national response rate). Forty percent of all births occurring during the study period were managed solely by a hospital midwife. The provision of midwifery care in the hospital setting was not universal, and where present, hospital-based midwives were not necessarily available 24 hours a day or 7 days a week. Hospital-based midwives reported a high level of autonomy.DISCUSSION: Currently there is no universal provision of midwifery care in the hospital setting in the Netherlands. Where there are hospital-based midwives, they appear to manage the majority of births. However, there are no nationally agreed-upon standards for midwifery practice in the hospital setting, and no agreement exists over minimum requirements relating to additional education for midwives in these settings. A national evaluation and setting of minimum standards is needed.