Doc ends delivery run

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On a good run, it took Alastair Haslam 12 minutes to get from his Tamahere home to his work at Waikato Hospital.

Al Haslam
Al Haslam (Photo: Nick Reed, Fairfax)

He’s done that trip in emergencies at all hours, the master of instant transition from family man to obstetrician, and probably a difficult birth awaiting his attention. Haslam borrows a quote he likes, the source unknown, to describe the effect of his quick exit. “The obstetrician is the empty place at the dinner table, and the draught of the back door opening and closing as you go out to the car.”

Yesterday, Haslam did things differently: he exited Waikato Hospital, retired from his life’s work as an obstetrician and gynaecologist, went home to get on with something different, and maybe to spend as long as he chooses at the dinner table with wife Sheila and any passing family, writes Denise Irvine of the Waikato Times.

His wife and four children have given him huge support in a job with huge, often unsociable hours. He met Sheila when he worked in the UK in the 1970s; he claims he dragged her out to New Zealand.

He may do some writing, reading, travelling. Maybe there is a personal spin-off from TV series Call the Midwife that he could write? Perhaps Call the Obstetrician, with Stephen Fry playing Haslam? Haslam’s been on stage as an actor himself a few times over the years, including a memorable part in Maurice Shadbolt’s Gallipoli play, Once on Chunuk Bair, so he could actually take the lead. Maybe not. He reckons his acting days are done.

These retirement possibilities, and the quip about dragging Sheila to New Zealand, are delivered with Haslam’s good humour and deep belly laugh, and during an interview at his bailiwick on the top floor of the Elizabeth Rothwell Building there is a goodly sprinkling of the irreverence he’s noted for, along with the serious stuff. He’s got a bit of time to talk on one of his last mornings, the next day he’s off to do a clinic in Tokoroa.

Haslam was elected chairman of the hospital’s obstetric and gynaecology unit in 1988, and was clinical director of O & G (under various other titles) until 2008, when he thought it was time to give younger staff a go. “It’s been a huge job, with conflicting priorities, and people to manage.”

At one stage, his designation was changed to Clinical Unit Leader (CUL). Haslam baulked at that, continued to sign himself director. “Cul is French for arse,” he says, “I never used that term.”

He was critical of the design of the delivery suite in the women’s hospital, opened at Waikato in 1979. The suite was in the middle of the new building, with no external windows. “No daylight,” he says, “it took 30 years to upgrade it.” Haslam wrote about this in the New Zealand Medical Journal, describing it as how not to build a delivery suite. It didn’t go down well at the hospital. “I must have been an arrogant young bugger.”

In the past few weeks, Haslam’s had a round of farewells, he’s been made an emeritus consultant at Waikato, and the man who first set foot in the place as a student doctor in 1968 has been well honoured. He’s now 67, and a holiday last year in South America solidified the notion that it was time to leave.

Haslam’s never really kept his own statistics on how many babies he’s delivered. There have been 100,000 born on his watch at Waikato, although he has not been involved in all of these. “I stopped counting after a few years, you might just do part of a delivery.”

He frequently meets people who utter the inevitable line, You delivered me. “There are people everywhere.” He’s joked with some that he first knew them as a positive test and a smudge on an ultrasound.

He kept a casebook of his first 20 deliveries as a student, but it suffered water damage while in storage at his parents’ home in Wellington. “Mum threw it out.”

He doesn’t remember much about his first delivery, apart from being terrified at the time. “It’s a very dark, lonely place at four o’clock in the morning.” He didn’t deliver his own children. “But I was there.”

Haslam’s been hugely loyal to Waikato Hospital. It was at Waikato that he decided to specialise in obstetrics and gynaecology, and apart from periods in the mid-1970s spent training at hospitals in Auckland, then in the UK, Waikato has been his patch. From May 1978 till yesterday, he’s been at the Village on the Hill without interruption, working part-time in private practice as well as serving on a number of medical-associated organisations, and lecturing at Auckland University’s medical school.

“One thing led to another at Waikato, they were very encouraging to junior people here, they encouraged me to flourish.” He mentions obstetricians Bill Fraser, Bob Gudex, Ru Pirritt and Mercia Barnes from earlier times. His colleagues say that in turn, Haslam has given back to many others who’ve come under his wing. He’s proud of the tally of 93 registrars whose training he’s been part of.

Dr Narena Dudley trained under Haslam, and says he was a wonderful boss, always accessible to his staff and patients, always available to help. “As a registrar on call with him after hours, if I needed help I’d call and he’d come.”

Dudley is now the acting clinical unit leader, doing Haslam’s old job. Technically she’s been his boss but she says it hasn’t felt like that. “He is a learned colleague who I still go to for advice, it is sad to lose him in the department, it leaves a big hole. He has great mana.”

Haslam says he liked obstetrics from the start. “You never know what you were going to be dealing with each day, what would come through the door. There is drama, tension, happy patients.”

In 1978, when he returned from the UK, he was quite struck with how relatively advanced the thinking was at Waikato, the adaptation of technology and the attitudes towards women.

Earlier, when he’d worked National Women’s in Auckland, he’d seen long corridors of pregnant women sitting on benches, being shunted through for their clinic appointments; it was like seeing catching pens in shearing sheds. There was a better attitude at Waikato.

In the late ’60s, there was a great lack of the medical givens of today. Haslam reels them off: No foetal monitors, very few epidurals, no ultrasound, no laproscopy, no Neonatal Intensive Care Unit, no managers, no independent midwives, forceps deliveries were preferred to ventouse (a vaccum device), there were no cellphones, just pagers that needed charging.

But whatever the decade, Waikato’s obstetrics team has always dealt with the challenging cases, pregnancy problems such as bleeding, high blood pressure, other medical disorders, as well as unborn babies with slowed growth, and abnormalities that may be treatable after birth or untreatable sometimes.

They look after women bearing twins, or who have breeches, and the operative deliveries (forceps, ventouse and caesareans). Haslam says obesity is currently causing problems such as stillbirth, growth problems in the baby (too much and too little), plus difficulties with birth and complications afterwards.

Then there’s been his work in gynaecology with its range of problems: menstrual disorders, pain, prolapse, urinary incontinence, cancer, fertility delays, contraception and abortion.

Running alongside all this for Haslam has been the politics of health care, the sometimes messy business of change, and of being an integral part of the hospital management team.

In the late 1980s and early 1990s, the demands on the country’s health budget brought wide-ranging reforms, and significant new managerial systems for public hospitals. The days of informal arrangements among staff ended, everything had to be signed off, and commercially minded managers and health professionals were sometimes at odds.

Haslam says those who come in from the outside sometimes struggle with the curious mix of public hospitals, the conflicts between the requirements of management, financial control, and altruism.

His view: “Hospitals are here to look after people who are sick, that is the beginning and end of it. We have limited resources, we have to use them well.”

He’s an optimist, but there have been some difficult moments. He mentions that he was under pressure to resign in the mid-2000s, a time when he says “you never knew who your friends were”. He doesn’t elaborate, but says there were a lot of people in acting roles, and some unproductive politics. “I hated it, it was not the happiest time.”

He thinks the system could still do better in looking after its staff, and encouraging them. He’s aware of some stressed medical people, he doesn’t like that. Haslam has also seen major changes in delivery (no pun intended) of obstetric care, namely the rise of midwives as lead maternity carers, and the demise of the traditional obstetrician-GP.

This was signalled by the Nurses Amendment Act 1990, which reintroduced autonomous midwifery practice in New Zealand. Midwives became increasingly responsible for managing normal births, with most women nowadays choosing a midwife as their lead maternity carer. Most GPs have stopped delivering babies, and women choose between a midwife or a specialist obstetrician.

Haslam thought it would take 10 years for this to bed in, he reckons it’s taken 20 years and it’s still not perfect. He says the change was inevitable, he didn’t oppose it. “You could see what midwives were capable of doing, and why couldn’t they take that extra responsibility.”

But it was a huge shift of responsibility; he says it raises the question of whether midwifery training is good enough. “The training is as good as it can be, but it is the gaining of experience in a supervised and mentored way that doesn’t come easily or quickly, the human interactions and judgments.”

Haslam saw antipathy from GPs who lost a large part of their practice and income as pregnant women switched to midwives. The adjustments on both sides have taken a long time; he says the system has to work, because it’s never going back to how it was.

The decline in New Zealand’s perinatal and maternal mortality rates is encouraging, and Haslam is pleased that these statistics are being reliably measured because there was a period when this wasn’t happening.

He says there have been some wrong judgments by midwives, with bad outcomes; this also occurred when GPs were delivering babies. He’s had some difficult outcomes himself during his career. “It’s pretty awful (when things go wrong).”

Haslam has also been a researcher, teacher, and examiner, and in 2010 he was awarded a Distinguished Service Medal by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the professional body which he has taken an active part in for decades, holding a variety of offices.

In awarding the medal, the college commended Haslam as having represented the cause of women’s health “with great wisdom and integrity”.

The doc himself says modestly that obstetrics has been demanding, never dull. ” I’ve enjoyed it.”

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