58 2 CHAPTER 2 Our analysis offers a new perspective on the usual framing of midwives and obstetricians as adversaries: instead of viewing disputes in MNC as a division between professional groups, we found these disputes are the result of opposing beliefs and interests that vary within professional groups. This insight can be used to de-escalate arguments about jurisdiction in MNC, offering a way to overcome stalemates based on narrow conceptions of professional beliefs and interests. Douglas (1990; 1992) argues that assigning responsibility for risk allows the allocation of blame, a process that appears to be at work in the current dispute between midwives and obstetricians in the Netherlands. Given their authority as gatekeepers, assigned by the SGKL, midwives are seen as responsible for perinatal mortality rates, allowing obstetricians to challenge that authority. Further analysis of the role of the relationship between risk, accountability, and blame will deepen our understanding of interprofessional disputes and boundary work in MNC. Strengths and limitations We believe we are the first to analyse the SGKL’s decision to give midwives authority over risk assessment and referral. Grounded theory analysis has enabled us to not only understand how, but to suggest why this decision was reached. As such, we are able to extend the understanding of the politics of boundary work. Our study has several limitations. The SGKL’s work took place almost 35 years ago, creating various problems of recall bias. We helped participants refresh their memories before the interview by sending them relevant documents of that time. To allow all respondents to talk freely, we agreed to confidentiality in reporting. Nevertheless, it is possible that the political sensitivity of the subject at the time of the study caused some participants to be cautious in their responses. While we did reach data saturation in the theme of ‘underrepresentation’ of one of the two ‘schools’ of obstetricians, we did not reach data saturation in all our findings because of the small sample size and the heterogeneity of our sample. To enhance our study’s validity, we performed a member check and triangulated our data sources, using interviews and archival material. Conclusion Our study provides new insights into professional boundary demarcation and the assignment of authority over risk management that occurs at the political and regulatory level of MNC. We found that beliefs regarding risks associated with pregnancy and birth, and not just professional interests in money and power, played a role in professional boundary work. Professional beliefs and interests are intertwined and can differ not only between but also within professional groups. As such, opposing stances can align transprofessionally and enable coalitions between sub-groups of different professions engaging in negotiations to protect and extend professional boundaries. Efforts to successfully implement healthcare reforms must actively address the interests andthe beliefs of the professions that are affected by the reform. Our findings offer a new perspective on the usual framing of midwives and obstetricians as adversaries: as opposing beliefs and interests that vary within professional groups instead of a division between professional groups. These insights can reframe policy discussions around risk in MNC and other areas of health care. 20 B. Goodarzi et al.