Family Ties Keep One Rural OB-GYN Practicing in Eastern NC, Despite Challenges - North Carolina Health News
By Taylor Knopf
It doesn’t take long to find a woman in the northeastern coastal town of Elizabeth City who had a baby delivered by Dr. Lindsay Stevenson, one of only two OB-GYNs in the area.
Samantha Merritt was a little nervous to deliver her first child in the small, rural town of about 18,000 people. She had lived in Elizabeth City once before when her dad served at the Coast Guard base there. After college in Wilmington, she and her husband, who is also in the Coast Guard, were stationed back in Elizabeth City.
Her concerns soon faded as she found giving birth to her son Ezra at Sentara Albemarle Medical Center to be a “very personal experience.”
“I was one of two people delivering,” she said. “Stevenson checked on me like six times, and it was just me and the labor and delivery nurses.”
It was important to Merritt that she didn’t feel rushed or encouraged to have a cesarean delivery. She was in labor for 38 hours.
North Carolina has a 29 percent cesarean (C-section) delivery rate, near the middle of nationwide rates, but has the lowest C-section rate in the south. And Sentara Albemarle Medical Center has a 13 percent C-section rate, one of the lowest in the state.
Stevenson said keeping that low rate boils down to simply having patience.
“I walked for 18 hours of my labor just trying to get him out,” Merritt said. “But Stevenson was super calming. He knew my birth plan and he actually read it, which was nice. When we got to 18 hours, I felt like I was falling asleep. But I wanted to have Ezra without a C-section. So Stevenson worked with me and talked to me about the medicine. He was never in a rush.”
Because they are a military family, Merritt expects her little family will soon move.
“But if I could have every baby here, then I would,” she said. “It was that good.”
Stevenson, 57, has spent almost his entire career caring for women and their newborns in his Elizabeth City hometown. He said nationally, OB-GYNs stop delivering babies on average at age 49, but he doesn’t plan on retiring any time soon.
It runs in the family. His father, Paul Stevenson, still works at the family-owned and run pharmacy on the main drag downtown. The elder Stevenson is 86 years old and said he’s only working part time now.
“But I’ll never quit altogether,” he said between filling prescriptions last month. The pharmacy was established in 1925 by Paul Stevenson’s father. And now, Paul’s other son, Nick, runs the family business.
“It’s been a struggle for the independent pharmacy, the past 30 years,” Paul Stevenson said. “The chains have become dominant. But we have a wonderful clientele of customers that have stayed with us. We appreciate them. Customer service is our motto, and that’s what’s kept us in business.”
The pastel pink walls and old-fashioned signs inside the pharmacy give it a welcoming feel.
Lindsay Stevenson is quick to say that the reasons he’s practiced medicine in Elizabeth City for the past 23 years are his family ties and the community. He spent two years practicing in Greenville, where he went to medical school.
“It wasn’t for me,” he said. “Greenville was a nice practice, but it wasn’t my home.”
A change of tune
But it hasn’t been easy. There were a few years where Stevenson didn’t have a medical partner and was on call 24/7.
“People were coming and going, and I was the last man standing,” he said.
Now he has one partner in his practice and the two of them are responsible for delivering every baby at the hospital, which fortunately sits across the street from their offices. Stevenson is on call every other day.
“It’s a collaborative labor of love and a good environment,” he said of working in Elizabeth City. “I think that’s what makes rural hospitals and practices tick, you’re not about the almighty dollar.”
“I was committed to being a poor musician,” joked Stevenson who started out with a degree in music education, played trombone, and worked as the public school band director in Elizabeth City for two years before going to medical school.
“I have a comfortable life, but it’s not about making money.”
The joys and struggles of rural medicine
Pasquotank is fortunate to have two OB-GYNs; 26 counties in North Carolina have none.
Stevenson serves patients from seven counties: Pasquotank, Perquimans, Camden, Chowan, Currituck, Bertie and Gates. There are only two hospitals in the area, but because the counties are geographically small, most patients are, at most, about 25 miles from a hospital.
However, if a patient is considered too high risk or delivers a baby earlier than 35 weeks, Stevenson sends them to either Greenville or Norfolk, Virginia, for care.
When it comes to prenatal care, much is done through the seven county health departments which work together as Albemarle Regional Health Services. Stevenson is the supervising physician for all women’s health care for ARHS. He and his medical partner also staff a low-risk and high-risk pregnancy clinic for the seven-county region.
“The health department is the muscle of how we can reach out to folks,” he said. Every county health department has nurse practitioners that provide prenatal care for low-risk patients.
Every Thursday, he runs the high-risk clinic through the Elizabeth City location. ARHS provides transportation from all seven counties to help women get the care they need, whether it’s visiting the high-risk clinic or going for a specialty consultation in Norfolk.
Lack of preventative care
Getting women to prenatal and postpartum care are the most difficult for multiple reasons, Stevenson said. First, the insurance gap causes problems.
“There are those who make enough for insurance and those that qualify for Medicaid, then those who get stuck in between,” Stevenson said. “That’s the group that sometimes doesn’t get prenatal care because of financial restraints.”
Sometimes he will see those patients while pregnant, but after the baby is born, they lose insurance coverage and he won’t see them again.
Stevenson said there are also those who are not educated on the need for prenatal care. If they’ve had a baby before and everything went well, he said sometimes they skip prenatal care the next time.
Then there are women who don’t seek prenatal care because they don’t want to expose their substance use, he said. About half of the patients who come through the hospital to give birth who’ve lacked prenatal care test positive for drug use. Those babies born with opioid dependence must be sent to Norfolk for any medical treatment, he said.
Another challenge Stevenson encounters are the chronic diseases more prevalent in low-income rural areas, such as obesity, diabetes and hypertension.
“When they come to us as a pregnant patient and already smoking, have high blood pressure and diabetes, and they are obese, we can’t correct those chronic conditions. All we can do is try to control them the best we can.”
Who will take my place?
Stevenson said officials at Sentara Albemarle are all working to recruit a third person to the area and the OB-GYN practice. But he’s worried about who will succeed him.
“I’m wondering who is going to be crazy enough to be on call every other night, or every third night,” Stevenson said.
The call burden wears physicians down. When physicians leave residency, he said they are looking for a practice where they can be on call about once a week.
“So they look at a practice like mine, and they don’t even call,” he said. “So we are kind of the lesser desired destination…. The people that practice in rural places, they either have connection through family, or they love the area.”
He added that physicians often look for a place with more educational and cultural resources for their family, which leads them to larger cities.
“Part of the answer has been the discussion of midwives,” said Stevenson, who works with them and thinks they have a lot to offer. But there still needs to be a physician if surgery is needed, he added.
“I don’t know that I can deliver babies until I’m 85,” he said, referencing his father. “There is a certain amount of physical stamina that’s required. I get my exercise running through this parking lot and up three flights of stairs into labor and delivery. My time is going down. I use to be able to make it in 35 seconds. Now I’m up to 42.”
Asked if any of his children would follow in his footsteps, he shook his head.
“I think they saw dear old dad laboring just a bit too hard,” he said, laughing. “All of them are musical. They saw dad having lots of fun doing musical stuff.”