to understand how this system came to be, we studied the work of the 1987 Study Group for the Revision of the Kloosterman List’s (SGKL), the committee largely responsible for the existing system of risk selection in the Netherlands. We analysed the minutes of the SGKL’s meetings and conducted interviews with eight key-informants who were involved in the SGKL’s decision process. Our analysis of the negotiations between representatives of midwives, general practitioners, and obstetricians in the SGKL was based on theories of professional boundary work and cultural theories of risk. We found that the work of the SGKL was political in nature, with decisions being determined not only by professionals’ understanding of risk but also by concerns with protecting their interests. At that time, two idea systems existed in Dutch MNC regarding risk: ‘conservative’ and ‘progressive’. The ‘conservative’ idea system was prominent in the North of the Netherlands, and was distrustful of new technology and hesitant towards the use of medical technical interventions. Professionals with ‘conservative’ ideas had little interest in protecting their position, power, and income. The ‘progressive’ idea system, prominent in the South of the Netherlands, advocated the use of technologies asmeans to safer birth andbetter outcome andwasmore concernedwithprotectingprofessional interests. As expected, we found that the beliefs and interests differed between midwives and obstetricians. But surprisingly, we also found variation within professional groups. This intra-professional variation led to trans-professional coalitions, creating the conditions that allowed SGKL members to find common ground in ‘conservative’ principles. This resulted in the unexpected decision to formally grant midwives ― who historically had been the subordinate group in MNC ― the authority to conduct risk selection autonomously. Our findings offer the opportunity to reframe policy discussions in MNC as occurring between beliefs as well as interests, instead of between professional groups, pointing to the need for further analysis of the boundary work that occurs in the political and regulatory arenas. The organisation of risk selection Our nationwide survey of all primary midwifery care practices and obstetrics departments gave us the opportunity to explore the different models of risk selection (MRS) used in the Netherlands, contributing to a richer understanding of the organization of risk selection. Different approaches to MRS have arisen from experiments in the past decade in addition to the usual MRS, where primary care midwives are responsible for risk selection. We identified three MRS, which were distributed differently across the Netherlands. The majority of midwives and obstetricians — mainly located in the North-West region of the Netherlands — worked according to the usual MRS, where primary care midwives assess risk, and, when necessary, initiate a consult or transfer of care after the booking appointment, without consulting an obstetrician. A second MRS —used mainly in the Southern region of the Netherlands — gives a greater role to the obstetrician: after the booking appointment, primary care midwives assess risk and make the decision to consult or transfer care in collaboration with obstetricians. In the third model —found mainly in 160 7 CHAPTER 7
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