39 Risk and the politics of boundary work: preserving autonomous midwifery in the Netherlands Bahareh Goodarzi *a, Lianne Holtena, Carla van El b, Raymond de Vries c, Arie Franx d and Eddy Houwaart e aAmsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG - Amsterdam Public Health research institute, Amsterdam, The Netherlands; bAmsterdam UMC, Vrije Universiteit Amsterdam, Community Genetics Department of Clinical Genetics, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; cAcademie Verloskunde Maastricht, Zuyd University, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; dDepartment of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands; eDepartment Health, Ethics and Society Faculty of Health, Medicine and Life Sciences Maastricht University, Maastricht, The Netherlands (Received 14 February 2018; accepted 8 December 2018) Midwives’ position in maternal and newborn care (MNC) in the Netherlands is unique: unlike many other countries, they have retained the authority over risk assessment and referral. We studied why and how midwives formally gained their position as gatekeepers, a role formally granted in 1987 by the Study Group for the Revision of the Kloosterman List (SGKL), a group of representatives from all professions and organisations involved in Dutch MNC. 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. We used theories of professional boundary work and cultural theories of risk to analyse the negotiations regarding the authority over risk assessment and referral in MNC that occurred between the representatives of midwives, general practitioners, and obstetricians in the SGKL. Our study offers new insights into professional boundary demarcation and the contest for control of risk management that occur at the political level of MNC. We show that beliefs regarding risks associated with childbirth and concern with the protection of professional interests can differ not only between but also within professions that seek to police and extend their boundaries. Negotiations are shaped by a dynamic interaction between these beliefs and interests, creating the possibility for otherwise unexpected transprofessional coalitions and redefining boundaries in unexpected ways. Our findings offer the possibility to view disputes in MNC as occurring between beliefs and interests, instead of between professional groups. These insights can reframe policy discussions in MNC and point to the need for further analysis of the boundary work that occurs in political and regulatory arenas. Keywords: maternity care; risk; boundary work; cultural theory; politics; medical history; schools of thought *Corresponding author. Email: b.goodarzi@vumc.nl Tweetable abstract:New insights into the role of #risk in the #politics of #boundarywork: preserving autonomous #midwifery in the Netherlands is the result of #transprofessional alliances in #negotiating professional boundaries. @MidwferyScience #HealthRiskandSociety © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
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