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55 2 RISK AND THE POLITICS OF BOUNDARY WORK into how professionals negotiate and define jurisdiction. Two phenomena played a critical role in the SGKL’s negotiations: beliefs regarding risks associated with pregnancy and childbirth and concerns with protecting professional interests. In examining the dynamic interaction between beliefs and interests, we found different points of view not only between professional groups, but also within professional groups. Our analysis reveals that differing stances can converge, creating a basis for alignments between sub-groups of professions, and making possible transprofessional coalitions that redefine professional boundaries in unexpected ways. How midwives won a battle they did not fight Like others (Instituut Geschiedenis der Geneeskunde Nijmegen, 1981; Verhoeven, 2013), we found that ‘conservative’ and ‘progressive schools’ existed within the profession of Dutch obstetrics, with diverging beliefs about the risks associated with pregnancy and birth. Moreover, our analysis reveals that these ‘schools’ also had different levels of concern about their position, power, and income. Our participants used the term ‘schools’ to emphasize the division among obstetricians. In sociology (Amsterdamska, 1987; Fleck, 1979; Kuhn, 1970), ‘schools of thought’ are described as groups or communities that approach the same subject from various incompatible points of view. Schools are held together by a common, historically rooted idea system that differs from other schools in their discipline or speciality, or from the discipline or specialty as a whole. Diverging idea systems generate competition and disputes between schools. Viewing the SGKL’s decision process through this lens allows us to see that beliefs and interests can differ between and within professional groups. Our analysis extends this perspective by showing that beliefs and interests are intertwined can interact, allowing opposing positions to align between sub-groups of different professions and across professional boundaries, offering the possibility for otherwise unexpected transprofessional coalitions. In the SGKL, the two schools in Dutch obstetrics were unevenly represented. When the first representative of the obstetricians left the SGKL, a strong proponent for the ‘progressive’ school was lost, resulting in the overrepresentation of the ‘conservative’ stance. At the time of the SGKL’s work, the prevailing perspective of the government about healthcare provision leaned toward the ‘conservative’ stance. Healthcare expenses were rising as a result of the increasing use of specialist care. To address this problem, in 1974, the Dutch Government decided to invest in primary care. The healthcare system was reorganised around two echelons, with the GPs given the key position of gatekeeper (Hendriks, 1974; van Osselen, Helsloot, van der Werf, & van Zalinge, 2016c). The government’s ‘conservative’ stance was reflected in MNC in efforts in favour of midwives’ position. Pregnancy and birth were believed to be primarily healthy processes, and midwives were considered experts in physiological midwifery (de Vries, 2005; Tweede Kamer van de Staten-Generaal, 1978; Veder-Smit, 1980). The SGKL used this political context as a guiding principle in their decision-making process. The policy of the chair ―that all decisions would be made content-based and consensus-based ―allowed for input from all SGKL members in the decision process, but at the same time it left little room in the deliberations for purely professional interests, such as money and power. Given the lack of scientific evidence supporting medical interventions, the chair’s policy suppressed the ‘progressive’ point of view in the SGKL. The GPs were, at first, of two minds on the question of who should be responsible for risk assessment and referral in MNC. Retaining jurisdiction as gatekeeper would have Health, Risk & Society 17

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