56 2 CHAPTER 2 been in their professional interest. In the end, however, the GPs’ stance against the increasing medicalisation in healthcare (van Osselen, Helsloot, van der Werf, & van Zalinge, 2016a; van Osselen et al., 2016c), their strong belief in the gatekeeper system as a brake on medicalisation (van Osselen, Helsloot, van der Werf, & van Zalinge, 2016b), and their declining interest in, and skills for, providing midwifery care (Aulbers & Bremer, 1995; van Alten & Treffers, 1981), led them to support midwives as the gatekeeper in MNC, supporting the ‘conservative’ stance in the SGKL. The politics of risk in boundary work Theories on boundary work point out that decisions regarding jurisdiction are influenced by the interactional context in which negotiations take place (Martin et al., 2009; Nancarrow & Borthwick, 2005). In the SGKL, a combination of the political climate, the leadership of the chair, the stance of the GPs and the imbalance between the ‘conservative’ and ‘progressive’ schools in obstetrics resulted in the ‘conservative’ policy recommendation of the SGKL. Its members found common ground in ‘conservative’ principles, which led to the decision to grant midwives the authority as gatekeeper in MNC. Our study demonstrates the importance of a historical-constructionist approach in studying social processes (Allotey, 2011; Charmaz, 2014; Seaman, 2008). Had the SGKL worked in a different time or location, with different prevailing beliefs and interests regarding pregnancy and birth, or had the SGKL included other people, with different orientations toward birth and risk and other interests, the result of their deliberations may have been different. Using classical boundary work theory, one would expect the SGKL’s work to have favoured the GPs or the obstetricians, especially because historically midwives have been the subordinate group within MNC (MacDonald, 1995; Witz, 1992). Indeed, the strongest voice in the SGKL was the biomedical voice of the GPs and obstetricians. However, the transprofessional coalitions allowed the SGKL to reach an unexpected decision: to broaden the jurisdiction of midwives and limit that of GPs and obstetricians. Although Abbott (1988, Chapter 3) noted that boundary work occurs on the work floor and in the political arena, the majority of contemporary research on jurisdictional disputes between professionals ― even studies of risk governance ― stop short of analysis of the establishment of authority in the political domain (see for example Chadwick & Foster, 2014; Healy, Humphreys, & Kennedy, 2016b; Hunter & Segrott, 2014; Hyde & Roche-Reid, 2004; Scamell, 2016; Scamell & Alaszewski, 2012; Scamell & Stewart, 2014; Spendlove, 2018). This gap in boundary work theory has been noted by other scholars (Bucher, Chreim, Langley, & Reay, 2016; Feyereisen, Broschak, & Goodrick, 2017; Salhani & Coulter, 2009). Salhani & Coulter, for example, observe that while concepts of power, ideology, and autonomy have been explored, their combined role in boundary work remains unpursued. They argue that these ‘[…] analyses remain substantially incomplete without such a political elaborated perspective […]’ (Salhani & Coulter, 2009, p. 122). Our study begins to fill this gap, examining how, in the political arena, beliefs and interests can create unexpected alliances and transprofessional coalitions. Professions that engage in boundary work contest and defend understandings of risk because definitions of risk legitimize the distribution of power and authority (Tansey, 2004). Douglas (1966; 1990; 1992)) points out that the political contests over risk often appeal to ‘objective’ science, concealing the associated ideologies of risk. When political conflicts are merely treated as intellectual disagreements over 18 B. Goodarzi et al.