Risk and the politics of boundary work: preserving autonomous midwifery in the Netherlands

Bahareh Goodarzi, Lianne Holten, CG van El, Raymond de Vries, Arie Franx, Eddy Houwaart

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Midwives’ position in maternal and newborn care (MNC) in the Netherlands is unique:
unlike many other countries, they have retained the authority over risk assessment and
referral. We studied why and how midwives formally gained their position as gatekeepers,
a role formally granted in 1987 by the Study Group for the Revision of the
Kloosterman List (SGKL), a group of representatives from all professions and organisations
involved in Dutch MNC. We analysed the minutes of the SGKL’s meetings
and conducted interviews with eight key-informants who were involved in the SGKL’s
decision process. We used theories of professional boundary work and cultural theories
of risk to analyse the negotiations regarding the authority over risk assessment and
referral in MNC that occurred between the representatives of midwives, general
practitioners, and obstetricians in the SGKL. Our study offers new insights into
professional boundary demarcation and the contest for control of risk management
that occur at the political level of MNC. We show that beliefs regarding risks
associated with childbirth and concern with the protection of professional interests
can differ not only between but also within professions that seek to police and extend
their boundaries. Negotiations are shaped by a dynamic interaction between these
beliefs and interests, creating the possibility for otherwise unexpected transprofessional
coalitions and redefining boundaries in unexpected ways. Our findings offer the
possibility to view disputes in MNC as occurring between beliefs and interests, instead
of between professional groups. These insights can reframe policy discussions in MNC
and point to the need for further analysis of the boundary work that occurs in political
and regulatory arenas.
Original languageEnglish
JournalHealth risk & society
Publication statusPublished - 19 Dec 2018

Cite this

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title = "Risk and the politics of boundary work: preserving autonomous midwifery in the Netherlands",
abstract = "Midwives’ position in maternal and newborn care (MNC) in the Netherlands is unique:unlike many other countries, they have retained the authority over risk assessment andreferral. We studied why and how midwives formally gained their position as gatekeepers,a role formally granted in 1987 by the Study Group for the Revision of theKloosterman List (SGKL), a group of representatives from all professions and organisationsinvolved in Dutch MNC. We analysed the minutes of the SGKL’s meetingsand conducted interviews with eight key-informants who were involved in the SGKL’sdecision process. We used theories of professional boundary work and cultural theoriesof risk to analyse the negotiations regarding the authority over risk assessment andreferral in MNC that occurred between the representatives of midwives, generalpractitioners, and obstetricians in the SGKL. Our study offers new insights intoprofessional boundary demarcation and the contest for control of risk managementthat occur at the political level of MNC. We show that beliefs regarding risksassociated with childbirth and concern with the protection of professional interestscan differ not only between but also within professions that seek to police and extendtheir boundaries. Negotiations are shaped by a dynamic interaction between thesebeliefs and interests, creating the possibility for otherwise unexpected transprofessionalcoalitions and redefining boundaries in unexpected ways. Our findings offer thepossibility to view disputes in MNC as occurring between beliefs and interests, insteadof between professional groups. These insights can reframe policy discussions in MNCand point to the need for further analysis of the boundary work that occurs in politicaland regulatory arenas.",
author = "Bahareh Goodarzi and Lianne Holten and {van El}, CG and {de Vries}, Raymond and Arie Franx and Eddy Houwaart",
year = "2018",
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language = "English",
journal = "Health risk & society",
issn = "1369-8575",
publisher = "Routledge",

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Risk and the politics of boundary work: preserving autonomous midwifery in the Netherlands. / Goodarzi, Bahareh; Holten, Lianne; van El, CG; de Vries, Raymond; Franx, Arie; Houwaart, Eddy .

In: Health risk & society, 19.12.2018.

Research output: Contribution to journalArticleAcademicpeer-review

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AU - Franx, Arie

AU - Houwaart, Eddy

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N2 - Midwives’ position in maternal and newborn care (MNC) in the Netherlands is unique:unlike many other countries, they have retained the authority over risk assessment andreferral. We studied why and how midwives formally gained their position as gatekeepers,a role formally granted in 1987 by the Study Group for the Revision of theKloosterman List (SGKL), a group of representatives from all professions and organisationsinvolved in Dutch MNC. We analysed the minutes of the SGKL’s meetingsand conducted interviews with eight key-informants who were involved in the SGKL’sdecision process. We used theories of professional boundary work and cultural theoriesof risk to analyse the negotiations regarding the authority over risk assessment andreferral in MNC that occurred between the representatives of midwives, generalpractitioners, and obstetricians in the SGKL. Our study offers new insights intoprofessional boundary demarcation and the contest for control of risk managementthat occur at the political level of MNC. We show that beliefs regarding risksassociated with childbirth and concern with the protection of professional interestscan differ not only between but also within professions that seek to police and extendtheir boundaries. Negotiations are shaped by a dynamic interaction between thesebeliefs and interests, creating the possibility for otherwise unexpected transprofessionalcoalitions and redefining boundaries in unexpected ways. Our findings offer thepossibility to view disputes in MNC as occurring between beliefs and interests, insteadof between professional groups. These insights can reframe policy discussions in MNCand point to the need for further analysis of the boundary work that occurs in politicaland regulatory arenas.

AB - Midwives’ position in maternal and newborn care (MNC) in the Netherlands is unique:unlike many other countries, they have retained the authority over risk assessment andreferral. We studied why and how midwives formally gained their position as gatekeepers,a role formally granted in 1987 by the Study Group for the Revision of theKloosterman List (SGKL), a group of representatives from all professions and organisationsinvolved in Dutch MNC. We analysed the minutes of the SGKL’s meetingsand conducted interviews with eight key-informants who were involved in the SGKL’sdecision process. We used theories of professional boundary work and cultural theoriesof risk to analyse the negotiations regarding the authority over risk assessment andreferral in MNC that occurred between the representatives of midwives, generalpractitioners, and obstetricians in the SGKL. Our study offers new insights intoprofessional boundary demarcation and the contest for control of risk managementthat occur at the political level of MNC. We show that beliefs regarding risksassociated with childbirth and concern with the protection of professional interestscan differ not only between but also within professions that seek to police and extendtheir boundaries. Negotiations are shaped by a dynamic interaction between thesebeliefs and interests, creating the possibility for otherwise unexpected transprofessionalcoalitions and redefining boundaries in unexpected ways. Our findings offer thepossibility to view disputes in MNC as occurring between beliefs and interests, insteadof between professional groups. These insights can reframe policy discussions in MNCand point to the need for further analysis of the boundary work that occurs in politicaland regulatory arenas.

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