49 2 RISK AND THE POLITICS OF BOUNDARY WORK chairs. The first chair’s employment ended and the seat was replaced after the third meeting (Minutes 07-11-1983). The SGKL members among the participants emphasized that the second chair enforced content-based12 decision making ―which we understand as decisions based on substantive arguments and facts, preferably scientific evidence, even though relatively few studies were available (Associated documents no. 26 25-04-1985 & Associated documents no. 40 25-11-1985 25). The scientific advisor was assigned to support this process (Werkgroep Bijstelling Kloostermanlijst, 1987, p. 11). The chair also used consensus-based decision making. According to the SGKL members we interviewed, and as corroborated by the associated documents, the chair created a ‘decision trap’ by first reaching agreement about the guiding principles, and the three risk groups, before making decisions (Minutes 13-02-1984 & 12-03-1984, Associated document no. 6 & no. 43 March 1986, pp. 6, 7). Nonetheless, our data sources suggest that the chair’s working method left room for the input of the members of the SGKL and discussion in which everyone participated. One participant described the chair’s working method in the following terms: ‘[…] So first you discuss the principles. […] You lead them into a trap. There is no way back. Because they agreed to the principles. […] There were consensus-based decisions made where someone could say: “OK, based on the discussion, I have no reasons for being against it. I would rather not have it, but I will not resist it.” But I think that is still consensus. I mean, that is also how it works between me and my wife. […]’ (P1) The general practitioners’ support for the gatekeeping system Although GPs held exclusive authority over referral to secondary care, they eventually agreed to share the authority to refer in MNC with midwives. In contrast to their scientific society, their professional association ―responsible for advocating the GPs’ professional interests ―initially rejected this decision (Associated document no. 27) claiming it would ‘invade their territory’ and weaken their protected position as gatekeeper (Minutes 09-0985 & Associated document no. 49). As one participant pointed out: ‘[…] [GPs] did not so much fear the midwives’ authority to refer directly [to the obstetrician], but that GPs would no longer be involved. And that not just midwives, but other professional groups would claim the same. […]’ (P3) In the end, however, the GPs’ professional association agreed that midwives should be given the authority to refer. Analysis of our interviews and associated documents revealed four reasons for this change of position: Declining interest in midwifery care First, our participants explained that over the course of the second half of the twentieth century the GPs’ focus had shifted to family medicine, causing them to lose interest in midwifery care. One participant explained this as follows: ‘[…] The number of GPs practicing midwifery decreased dramatically. Hardly any were left. […] Because, during that time, major developments in the GP’s profession took place and a large part of their practice concerned psychological problems. GPs spent all their time talking to their patients. […] As a result, they had less time to practice midwifery. […]’ (P4) Health, Risk & Society 11