Dunedin Hospital has changed markedly since the 1990s and is now much more focused on patient care, the Otago District Health Board's new women's health clinical director, Dr Alex Teare, says.
Dr Teare, who returned to the hospital in 2006, said when he had previously worked in Dunedin in the 1990s there had been a "fair degree of disaffection" between medical staff and management.
On his return, he found there was a "tremendous focus on patient care and qualify of care" from management "all the way down", which was not evident before.
He is, however, disappointed the board does not yet provide a birthing unit for women expected to have low-risk labours.
It was not ideal to have such women coming into the same environment as the high-risk mothers.
Such a unit which would not be situated within the hospital, and would be of tremendous benefit to Dunedin and the surrounding area.
He said he advocated for such a unit whenever he got the chance, but the answer was always that there was no money for it.
Another ongoing issue for Dunedin Hospital, in common with other hospitals in the country, was the high Caesarean rate.
Dr Teare said there were a variety of contributors to this including that in the last six to nine months the hospital had dealt with a high number of high-risk pregnancies.
Some of these were cases referred from other hospitals because the neonatal intensive care unit in Dunedin was a "superb unit with an amazing ability to continue working under very difficult circumstances".
(The unit is one of several areas of the hospital which has been on the waiting list for a much needed upgrade, but the board is yet to hear if it has the money for this.)There were also an increasing number of mothers who wanted to have their second birth as a Caesarean if they had a Caesarean the first time.
They could be counselled about the risks of Caesarean section and the benefits of trying for a vaginal birth, but they could still choose a Caesarean.
There could be a variety of factors which would lead to that choice including family history of bad birthing experiences.
More first-time mothers aged in their late 30s and 40s was also a factor in the rates.
Asked about the state of the relationship between specialists and community midwives, Dr Teare said there were times when doctors had difficult relationships with "a very few of them".
Dunedin had an extremely large group of self-employed midwives which was almost out of proportion to the population and mostly doctors and midwives worked together "very happily and comfortably".
Good communication was the key to resolving any differences over patient care and hospital staff tried to do this through mediation, discussion and meetings to find common ground.
Dr Teare, who is from South Africa originally, has accepted that as a male obstetrician he is part of a dying breed.
Dunedin has only one male registrar in the field and about half a dozen women.
Across the country, the majority of those entering the specialty would be women, he said.
This was the reverse of the situation when he entered the profession and just one of the changes he had noted in the 23 years since his training.
The practice of obstetrics had been revolutionised in his lifetime, he said.
It was almost like science fiction.
Advances included surveillance of babies in utero through measures such as ultrasound scans, helping sick babies while they were still unborn and the ability to monitor labour more closely and drugs which could delay the onset of premature labour.
Before Dr Teare first came to New Zealand in 1990 to work at the then National Women's Hospital, he had undertaken work in Canada, setting up obstetric and gynaecology services at a small rural hospital in Newfoundland.
He first came to Dunedin 15 years ago and his several years in the city then included a stint in private practice, something which he did not "really enjoy".
After leaving, he took on the role of director of the Flying Obstetrics and Gynaecology Service working in remote southwest Queensland for several years before his return in 2006.
