It is not uncommon for midwives in Australian hospitals to order and interpret tests and initiate medications. The National Health and Medical Research Council only formally acknowledged these practices through recommendations in 1998. Successful extension of the midwife's role is assumed to be advantageous to the health-care system in its ability to satisfy consumer demand for a less medicalized experience and to be cost effective. This paper presents the results of the first phase of a three-phase fourth generation evaluation of the extended role of the midwife in two acute care settings in the Northern Territory, Australia. The results suggest that recognition of the extended role of the midwife has the potential to deliver high level continuous midwifery care to women, to increase work satisfaction for the midwives and to enhance professional autonomy and responsibility in the workplace. However, when compared with their counterparts in the United Kingdom and New Zealand, midwives in Australia continue to practice with considerable limitations placed on their autonomy.