52 2 CHAPTER 2 ‘[…] [The “conservatives”] said: no evidence exists for the benefit of primary involvement of the obstetrician […]. They continually asked themselves what the added value of the obstetricians was for all different indications. And that caused serious arguments! […]’(P5) The midwives and obstetricians amongst our participants pointed out that midwives’ views aligned more with the ‘conservative’ group of obstetricians who emphasized physiology and the midwifery model. Consequently, our participants explained, the division among obstetricians resulted in a division between midwives and the ‘progressive’ obstetricians, whereby both felt threatened by the other, with each fearing the loss of professional territory. ‘[…] The midwives feared that primary midwifery care would be handed over to the obstetrician, to specialist care. And that was a priori the obstetricians’ position. And the midwives opposed that saying “stay away from our patients”. […]’ (P2) ‘[…] A lot of animosity existed between midwives and obstetricians during that time. […] I believe this was also a bit based on finances. [The obstetricians] feared losing work. […]’ (P4) Our participants emphasized that the conflict between midwives and obstetricians mainly occurred at the level of professional associations representing the collective interests of the parties involved, while in practice their relation varied by region. Underrepresentation of the ‘progressive’ group Against this background of the division within obstetrics and the tension between obstetricians and midwives, our participants agreed that the obstetricians’ representative had views that aligned more with the ‘conservative’ school; they portrayed this representative as a student of a prominent professor of the ‘conservative’ school. Furthermore, according to our participants, this representative had good relations with midwives, and as an employee and researcher at an academic hospital had little interest in money and professional power. As one of our participants pointed out: ‘[…] [The obstetricians’ representative’s] philosophical approach, or rather professional approach, led to more leeway being given to midwives than the members of [representative’s professional association] would have liked. […] [The obstetricians’ representative’s] input was based on science, or as [the representative] was able to assess it. In doing so, [the obstetricians’ representative] did not bear in mind the other side, that of the professional interests. […]. I told [the obstetricians’ representative], be careful because you might support decisions that could harm the [professional association’s] interest. […]’ (P8) All of our participants explained that the obstetricians’ representative did not sufficiently communicate with the professional association of obstetricians during the work of the SGKL, and therefore failed to bring the beliefs and interests of the ‘progressive’ school into consideration in the SGKL’s decision process. Our data suggest two reasons for this. First, the professional association of obstetricians showed little interest in the SGKL’s work, not fully realising its significance Second, the obstetricians’ representative was convinced that applying the strategy of making decisions on the substantive arguments, facts, and scientific research would result in the support of all obstetricians. One participant referred to this strategy as ‘naive’: 14 B. Goodarzi et al.
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