47 2 RISK AND THE POLITICS OF BOUNDARY WORK check inter-coder reliability and to reach consensus on code definitions. We used qualitative data analysis software MAXQDA version 11.0.3 (https://www.maxqda.com/) in coding. The transcripts were first coded bottom-up using open codes and then categorized in themes. In the last step we analysed the interrelations between the themes in our search for an overarching theme or theory. Research team and reflexivity The first author is a midwife. Prior to the study, the participants were unknown to her. She graduated as a midwife 20 years after the SGKL had made its recommendations. As such, she had little knowledge of the content of their work. The first author was careful to ask critical questions about SGKL’s considerations to assign midwives as gatekeeper, and explored other options that may have been considered by the SGKL, including the option to assign GPs or obstetricians as gatekeeper. The research team was purposely composed of researchers from different disciplines, including an obstetrician, a medical historian, a medical sociologist and a medical anthropologist, and was involved closely in the whole research process. The topic list was reviewed by the team for neutrality, accuracy and consistency. The themes and core categories were discussed and agreed on by the entire research group (Charmaz, 2014; Hall & Callery, 2001). To improve the validity of the findings, we triangulated different data sources. We also conducted a member check ―presenting the interview transcripts to the participants and giving them the opportunity to respond with corrections or additional remarks. Four participants responded with minor corrections and remarks. Findings We interviewed eight participants who were involved in the SGKL’s decision process and analysed the SGKL’s meeting’s minutes and associated documents. According to our participants and the archival documents (Letter M.P. Springer to C.W.A. van den Dool 2903-1983, Letter J.B. Maathuis to C.W.A. van den Dool 20-05-1983), the professional associations of midwives, obstetricians and GPs had selected their own representatives. Two members represented the professional association of midwives and one member represented the professional association of obstetricians. The scientific advisor was selected by the Health Insurance Council and was assigned to offer scientific support (Werkgroep Bijstelling Kloostermanlijst, 1987, pp. 10–12). The chair and the secretary worked for the Health Insurance Council (Minutes 07-11-1983 p. 1). Analysis of the interviews and the documents confirmed various insights we had drawn from the literature review: although the SGKL was primarily assigned to revise the list of medical indications, they also gave midwives jurisdiction over risk assessment and referral. In this regard, we found four key themes: (1) the SGKL used established policy and viewpoints, emphasizing the physiology of pregnancy and birth as a guiding principle in the decision process, (2) the chairman enforced content-based and consensus-based decision making, (3) the GPs strongly supported the gatekeeping system and (4) one of the two ‘schools’ of obstetricians was ‘underrepresented’ in the SGKL. Physiology in primary care as the guiding principle in the decision process Our analysis of archival documents showed that the SGKL used previous advice and proposed policies as the guiding principles in their decision process: Health, Risk & Society 9
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