40 2 CHAPTER 2 Introduction The long-standing jurisdiction of midwives over risk assessment and referral in the Netherlands has recently been called into question, unfolding into a competition between midwives and obstetricians for authority over risk management in maternal and newborn care (hereafter, MNC) (de Vrieze, 2018; Koninklijke Nederlandse Organisatie van Verloskundigen, 2015; Ministerie van Volksgezondheid Welzijn en Sport, 2017). The existing division of labour is grounded in decisions made by a government–initiated study group in 1987. In the study presented below, we analyse this study group’s decision processes, in order to understand the historical underpinnings of the current tension between midwives and obstetricians. Using interview and archival data, we examined the study group’s decision processes through the lens of theories of professional boundary work and social and cultural theories of risk. Based on our analysis, we argue that the contest for control of risk management at the political and regulatory level is directed both by beliefs regarding the risks associated with pregnancy and birth and by professional interests. Our research shows how beliefs and interests are intertwined and interact, making possible transprofessional alliances in the redefining and reassigning of professional tasks and responsibilities. Our study contributes to empirical research on the politics of risk and professional boundary work. The jurisdiction of midwives in the Netherlands is called into question The autonomous position of midwives in the MNC system of the Netherlands stands out internationally (de Vries, Nieuwenhuijze, & Buitendijk, 2013; Rothman, 2016; van Daalen, 2017). In other developed countries, over the course of the twentieth century, midwives’ jurisdiction was increasingly constrained as a result of various social and cultural factors, and doctors assumed authority over childbirth (Donnison, 1988; Marland & Raffety, 1997; Oakley, 1984; van Teijlingen, Lowis, McCaffery, & Porter, 1999; Witz, 1992). Dutch midwives, however, are licensed as autonomous medical practitioners and have occupational jurisdiction over ‘physiological’ ―low-risk, healthy ―pregnancy and birth. A critical feature of this jurisdiction is responsibility for the assessment and management of risk. Dutch midwives serve as gatekeepers, deciding when referral to specialist care is necessary. This means that midwives, not obstetricians, control the flow of women from primary care to secondary care (Aitink, Goodarzi, & Marijn, 2014; Commissie Verloskunde van het College van zorgverzekeringen, 2003; Ministerie van Volksgezondheid Welzijn en Sport, 1993). Several events in Dutch history have contributed to the preservation of midwives’ position in MNC, including government support through laws, and the provision and regulation of education for midwives beginning early in the nineteenth century. These and other explanations, such as features of Dutch culture, have been described by several scholars in the field of sociology and medical history (Abraham– van der Mark, 1996; Benoit et al., 2005; Crébas, 1986; de Vries, 2005; de Vries et al., 2013; Klinkert, 1980; Marland & Raffety, 1997; Schultz, 2013; van Lieburg & Marland, 1989). However, no one has fully explored how and why midwives gained the formal authority over risk assessment and referral to specialist care. Over the last several years, the jurisdiction of Dutch midwives as gatekeepers has been called into question by the professional association of obstetricians and supporters of a more risk-focused and medicalized approach of MNC. A few studies pointing to relatively high perinatal mortality rates in the Netherlands (EURO-PERISTAT project, 2004; 2010; Evers et al., 2010) ―albeit employing methods and offering interpretations 2 B. Goodarzi et al.
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