42 2 CHAPTER 2 event – a risk. Douglas and other cultural theorists of risk argue that this modern concept of risk is politicized and is used to encourage acquiescence to power and authority and assign accountability (Douglas, 1990; Tansey & O’Riordan, 1999). Pregnancy and childbirth are pertinent examples of the relationship between risk, power and authority. In contemporary MNC, pregnancy and birth are increasingly translated from‘dangerous’ to ‘risky’ ―from events that are natural and unpredictable to those that can be predicted, controlled, and made safe ―giving power to those who are the arbiters of, and protectors from, risk (Healy, Humphreys, & Kennedy, 2016a; MacKenzie Bryers & van Teijlingen, 2010). In the professional relationship between midwives and obstetricians, it is risk that sets the boundaries for working practices, defining the division of labour, authority, and accountability. Historically, this boundary work revolved around the distinction between physiology and pathology (Spendlove, 2018). Midwives were granted jurisdiction over physiology, and doctors claimed authority over pathology and the use of medical interventions. With the rise of the risk discourse in society and the advent of new technologies of monitoring and interventions, an increasing number of women have been moved from the category‘physiological’ ― ‘low risk’―to the category ‘pathological’ ― ‘high risk’ ―, shifting the professional role boundaries within MNC in favour of physicians (Donnison, 1988; Hunter & Segrott, 2014; MacKenzie Bryers & van Teijlingen, 2010; Oakley, 1984; Spendlove, 2018; van Teijlingen et al., 1999). Intense focus on risks in childbearing therefore extends the jurisdiction of doctors, resulting in an ‘ever-narrowing window’ (Scamell & Alaszewski, 2012) for midwifery with its emphasis on physiologic pregnancy and birth (Hyde & Roche-Reid, 2004; Lankshear, Ettorre, & Mason, 2005; Powell & Davies, 2012; Rothman, 2014). Boundary work and the role of risk in maternal and newborn care in the Netherlands The language of risk was implicit in early definitions of the professional boundaries between midwives and physicians in Dutch MNC. The 1865 Medical Act allowed both obstetricians and general practitioners (hereafter, GPs) to practice across the full scope of midwifery. The same law restricted midwives’ jurisdiction to ‘uncomplicated’ births and midwives were not allowed to use any instruments. The hospital setting was reserved for obstetricians only (Ministerie van Binnenlandsche zaken, 1865). In 1900, almost 98% of women gave birth at home (van Daalen, 1988, p. 417). Midwives used a list of medical indications, which distinguished between complicated and uncomplicated births, to decide when referral was necessary. As such, this list defined the boundaries for labour practices ―in both senses of the word ―in MNC. This list was derived from textbooks written by obstetricians for the education of midwives and obstetricians. Van der Mey & Treub (1887) described the birth process solely in terms of physiology and pathology. Their description was specified and expanded during the first half of the twentieth century as a result of increasing scientific knowledge and medical technology (Amelink-Verburg & Buitendijk, 2010; Hiddinga, 1995; Smeenk & Ten Have, 2003). In 1956, Holmer and his colleagues presented a detailed list of ‘expected difficulties’ and ‘unexpected events’. For these ‘medical indications’ (Holmer, Ten Berge, van Bouwdijk Bastiaanse, & Plate, 1956, p. 175), care in the hospital was advised. The term‘risk’ was introduced in the last list of medical indications as part of an educational textbook published in 1966 by Kloosterman. Although midwives decided when referral was necessary, the position of gatekeeper resided with GPs. Midwives were not authorized to directly refer women to the obstetrician. In case of risks or complications, they had to consult a GP. At the turn of the 4 B. Goodarzi et al.
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