When our good friend Dr. Angie Child Jelin, Assistant Director of Prenatal Genetics at Johns Hopkins Hospital, agreed to talk to us, a million questions came to mind. But between her job, two kids, busy husband (a pediatric surgeon also at Johns Hopkins), and dog, we were lucky to get even a small piece of her time.
Check out Dr. Jelin’s insights and let us know what you want to hear more about for our next chat! Email us at firstname.lastname@example.org.
You’ve practiced on both coasts – in San Francisco, Washington D.C., and Baltimore. What differences have you noticed in obstetrical practice nationwide?
I think differences in practice are hospital-dependent. They are based on type of provider (generalist obstetrician, midwife, higher-risk maternal-fetal medicine specialist) and hospital philosophy. There are national guidelines that are moving toward less cesarean deliveries and less preterm deliveries. The cesarean rate in San Francisco [at UCSF] was lower than in Washington, D.C. [at MedStar Washington Hospital], for example.
What exactly is a midwife?
A midwife is someone who is trained to care for women during pregnancy and attend vaginal deliveries. They generally have a certified nurse midwife (CNM) degree and are hired by many hospitals. It is recommended that they have rapid access to obstetrical services in case of any complications. They generally promote more natural births and women they care for have higher rates of vaginal delivery.
What are the most common reasons women book obstetric appointments?
Most prenatal appointments are for routine prenatal care. The most common concern in the first trimester is probably nausea. In the second trimester, there are more concerns for pain: round ligament pain or preterm contractions. In the third trimester, we see a lot of patients regarding preterm labor.
Are IUDs safe?
IUDs are a very popular form of birth control and are safe and effective. IUD options are Mirena (which works for 5-7 years) or PARAGARD (which works for 10 years). Mirena uses progesterone (a hormone). Mirena periods are usually less heavy but can be irregular or can disappear completely. With PARAGARD, women usually have regular periods, but they can be heavier.
What’s the most common form of birth control you’re prescribing today?
For long-acting birth control forms, IUDs are common as are implants (i.e. Nexplanon). I prefer NuvaRing over [oral contraceptives]. It’s similar to the pill, but is instead placed in the vagina. Most women don't even notice it is there, but it has to be replaced weekly.
What changes have you noticed in your years of study and practice within women’s reproductive medicine?
So many! Better long acting forms of birth control; the addition of progesterone as treatment for preterm labor; infants surviving at earlier gestational ages; the use of magnesium sulfate for neuroprotection in preterm infants; cell-free fetal DNA for trisomy screening; and microarray technology for invasive testing (to name a few).
What advice do you have for women looking to get pregnant?
Take folic acid and a prenatal vitamin! Any prenatal vitamin is fine. They all have folic acid and the recommendation is to start taking one three months prior to conception and to continue while breastfeeding. While it is recommended to take a prenatal vitamin with folic acid during this entire time period, the most important time is during the first trimester. Note: I don't know much about importance of folic acid for nursing, but it is important to maintain a healthy lifestyle while nursing so that you don't deplete important vitamins and minerals that are secreted in the breast milk.
Exercise during pregnancy – can you do too much?
The general recommendations are that exercise is healthy in pregnancy, especially if you have been exercising prior to pregnancy.
What are top causes of premature labor?
There are many causes of preterm labor and a lot of the time we don't know why: infection, inflammation, mechanical (twins). There are also many causes for iatrogenic (induced) preterm labor, mostly related to elevated blood pressures.
Is some wine during pregnancy okay?
As a physician I have to say that we don't understand the threshold for alcohol, but if you are looking for another answer, do ask your midwife.
What about foods? Sometimes it seems like everything is off-limits.
Recommendations are to avoid any food that could cause an infection during pregnancy, including bacterial contamination or protozoa. These include raw foods (meat or eggs), sushi, unpasteurized cheeses, and sandwich meats. Sandwich meats also have nitrates that have been speculated to be harmful. Fish that contain high levels of mercury should also be avoided, however there is more leniency on this recently due to benefits of omega-3 fatty acids.
What advice can you give from one working mom to another?
Make sure the time you spend with your family is quality time. Try not to bring work home with you - be completely engaged with your family when you are spending time with them. If you have any flexibility in your schedule, use it to prioritize events that are important to your kids. It might make more sense to work at night if it means you will make it to their play during the day.
You’d think motherhood for an obstetrician would be easier than for the rest of us, given you’ve seen it all. What’s been the biggest surprise in being a mom?
It doesn't seem like it's easier! I've realized the value of having a pediatrician to turn to when my child is ill instead of trying to take care of things myself. I've realized the difference in judgment when the patient is your child. I also didn't expect motherhood to be harder than work. I now understand why patience is a virtue and that kids really do grow up way too fast!
About Dr. Jelin
Dr. Angie Child Jelin is the assistant director of prenatal genetics at the Prenatal Diagnostic Center in the Division of Maternal-Fetal Medicine and an assistant professor in the Johns Hopkins Medicine Department of Gynecology and Obstetrics.
Dr. Jelin earned her medical degree from Harvard Medical School. She did her residency in obstetrics and gynecology at the University of California, San Francisco, and then remained there to complete a maternal-fetal medicine and genetics fellowship.