**Abstract**

Advanced midwifery practice is an autonomous status that is developed during midwifery training and practices. Advanced midwives in their practice are expected to take full responsibility when it comes to patients under their care. However, in tertiary hospitals, all the care given to maternity patients yields grey area which needs responsibility sharing between the midwives and other multidisciplinary team members like obstetric doctors and paediatric doctors. The tertiary environment is overclouded by medical-dependent practices which is widened by the communication gap between the multidisciplinary teams. Lack of professional communication in tertiary hospitals' work environment when it comes to sharing of accountability pushes the midwives to their cocoon shells which make them lose their patient advocacy role, knowledge, and skills. Based on the environmental expectations, set ups and practices, patients end up receiving compromised maternity care which open doors to major malpractices and complications like unnecessary loss of lives and litigations. In the presence of malpractices, there is always a tendency of the multidisciplinary team members blaming each other and mostly the blamed professionals are the midwives which strains the environmental professional relationships.

**Keywords:** advanced midwife, tertiary hospital, teamwork, multidisciplinary team, professional communication, and underutilization
