48 2 CHAPTER 2 ● The need to separate location of care from care provider in the list of medical indications in order to enable midwives to attend physiological birth in the hospital (Associated documents no. 6 & 21, Minutes 15-03-1983, 17-05-1983, 06-10-1986). ● The preference for primary care and home birth in the case of uncomplicated pregnancy and birth (Associated documents no. 6, no. 21 & no. 77 pp. 12, 13). ● The wish to enable midwives to directly refer to the obstetrician ―without the involvement of the GP (Associated document no. 21, Minutes 10-06-1985). ● The recommendation to improve collaboration between midwives, GPs and obstetricians (Associated documents no. 6, no. 21 & no. 77 p. 13, Minutes 13-02-1984). These guiding principles were introduced by the scientific advisor and later adopted by the chair, both of whom were members of the committees that had issued the advice and policies; respectively the Health Insurance Council (Werkgroep Bijstelling Kloostermanlijst, 1987, p. 11) and the 1979 Committee on the Organisation Maternal and Newborn Care (Werkgroep Verloskundige Organisatie, 1979, p. 11). Building on the guiding principles, the scientific advisor suggested to divide the medical indications into three risk groups, thereby separating the location of care from healthcare professional: (1) a low risk group with care provided by midwives/GPs at home/in the hospital, (2) a medium risk group with care given by midwives/GPs in the hospital with consultation of the obstetrician and (3) a high risk group with care provided by an obstetrician in the hospital (Minutes 1st meeting 17-05-1983 p. 3). The inspiration for this division was a proposal made by the professional association of midwives that suggested the addition of the medium risk group to the existing list of medical indications (Minutes 30-06-1983 p. 2). Having made the decision to differentiate the medical indications into these three risk groups (Minutes 07-11-1983), the SGKL had to decide who would be assigned with the authority over risk assessment and referral. The decision trap: content-based and consensus-based decision making In 1987, after 27 meetings over a period of nearly four years (Werkgroep Bijstelling Kloostermanlijst, 1987, p. 12), the heterogeneous members of the SGKL reached agreement about who would be given authority as gatekeeper ―to assign women to one of the three risk groups, as such deciding on referral to specialist care. According to our participants, it took them that long because these members were entrusted with representing both the beliefs about the processes of pregnancy and childbirth and the professional interests of their professional group. Several participants pointed out that the GPs’ beliefs and their professional interests were represented separately: their scientific society and professional association each had two members on the SGKL. According to our participants the decision process was dominated by professional interests, such as income, position and power. However, the four former SGKL representatives amongst our participants emphasized that the discussion about the professional interests ‘took place under the table’. One participant explained: ‘[…] It was all about the distribution of the pie. About money. […] That was dominant. […] But nobody would admit that. Because when you admit that it is about money, well, then you lose face. […]’ (P1) Despite the SGKL members’ contrasting professional interests, the SGKL managed to reach agreement because of the way the chair led the discussions. The SGKL had two 10 B. Goodarzi et al.