53 2 RISK AND THE POLITICS OF BOUNDARY WORK ‘[…] I think it was naive of [the obstetricians’ representative] to think: “it concerns substantive arguments that are sound. I agree with these arguments, therefore all obstetricians will agree with them.” That was in [the SGKL’s] advantage. Otherwise [the SGKL] would not have reached consensus. […]’ (P1) After the obstetricians’ professional association rejected the SGKL’s report (Associated document no. 51), a hearing was organised to discuss the arguments (Minutes 06-101986). Although the report of the hearing portrays the arguments of the obstetricians’ professional association as substantive in nature (Associated documents no. 51 & no. 60), the interviews and the documents show that the obstetricians’ representative and the rest of the SGKL perceived ‘emotion, money, and power’ (P5) as the main reasons for rejection. This passage from the minutes illustrates this position: ‘[…]The [obstetricians’ representative] says that […] the proposed changes go beyond the expectations [of obstetricians]. The [GPs’ representative] says to be of the opinion that so much information has “leaked” over the years, that the direction of [the SGKL’s] decisions should have been clear. The [obstetricians’ representative] says the report has nevertheless caused a “shock effect”. The shock is mainly emotionally and financially determined: the idea that pregnancy and birth with a medical indication will not automatically be assigned to secondary care is really hard […].’ (Minutes 06-10-1986 page 2) Analysis of the interviews and documents (Minutes 06-10-1986) show the obstetricians’ representative, like the other members of the SGKL, continued to support the SGKL’s decisions based on the commitment to, and belief in, the chair’s method of content-based decision making. Furthermore, the obstetrician’s representative believed there was a lack of scientific evidence to support the ‘progressive’ position. One of the participants explained: ‘[…] [The obstetricians’ representative] felt that the [SGKL’s] report was not rejected based on [arguments against the revised list of] medical indications, but just because [the obstetricians] felt that it would grant midwives too much power. […] [The obstetricians’ representative] continued to support the [SGKL’s] report. […] Because [the representative] believed it was right. Because [the representative] had contributed to it. [The representative] had nearly read all the scientific publications and was of the opinion that, yes, you can do that, you have to do that, because based on the current knowledge there is no other choice. […]’ (P4) The opposing force of the other members The obstetrician representing the professional association of obstetricians in the SGKL was replaced at the third meeting (Minutes 07-11-1983 & Associated document no. 68). Our participants agreed that the first representative was more ‘progressive’ than the replacement; more interested in protecting the interests of the obstetricians’ professional association. Analysis of the documents confirms this (Minutes 17-05-1983 & 3006-1983). Although our analysis shows that the second representative agreed to give midwives the authority to do risk assessment because this representative prioritized evidence over interest and the beliefs and interests of the ‘progressive’ group amongst obstetricians, we were also told that the obstetricians’ representative did advocate for the expertise and position of the obstetricians, and the importance of obstetrics in MNC. Health, Risk & Society 15
RkJQdWJsaXNoZXIy MjY0ODMw