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.

荷兰助产士在孕产妇和新生儿保健（MNC）中的地位是独特的：与许多其他国家不同，助产士保留了风险评估和转诊的权力。我们研究了助产士为什么以及如何正式获得守门员的地位，1987年由修订Kloosterman List（SGKL）研究小组正式授予的角色，该小组来自荷兰MNC的所有专业和组织。我们分析了SGKL会议的会议记录，并采访了参与SGKL决策过程的八名主要信息提供者。我们使用专业边界工作理论和风险文化理论来分析助产士，全科医生，SGKL的妇产科医生。我们的研究为跨国界政治层面的专业边界划定和风险管理控制竞赛提供了新见解。我们证明了有关分娩风险的信念并与专业利益的保护的关注，不仅可以相差之间也内寻求警察和扩大其边界的职业。这些信念和利益之间的动态互动影响了谈判的进行，从而为原本意料之外的跨专业联盟和以意想不到的方式重新定义边界创造了可能性。我们的发现提供了可能性，可以将跨国公司中的争议视为发生在信仰和利益之间，而不是专业团体之间。这些见解可以重新组织跨国公司中的政策讨论，并指出有必要进一步分析政治和监管领域发生的边界工作。