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Meet our OBGYN: Dr Jane Van Dis
My name is Jane van Dis, and I’m a board-certified Obstetrician/Gynecologist.
What I love most about my job:
I love that I’m able to provide women patient-centered and evidence-based care. It’s been my experience that a lot of women have felt dismissed or unheard in healthcare settings and it’s my wish that women not only receive the most up-to-date medical information informed by studies and algorithms that represent the highest quality evidence but also a sense that their goals and desires, fears and concerns are acknowledged and incorporated, where medically appropriate.
Personal notes:
I am a single mom to 13-year old twins, soon-to-be 8th graders. Both are excellent cooks, with one being vegan and the other being a meat lover. As a mom, my favorite activity is getting them to take long walks during which interesting conversation occurs in the absence of anything with the power switch. Biking is a favorite too, with destinations most in demand being coffee shops and craft supply stores.
Five most asked questions for a female OBGYN:
1-Do all women planning to get pregnant need to take prenatal vitamins?
One of the most important aspects of taking a vitamin in the preconception phase (ideally) is to make sure you have sufficient folate, as this helps to prevent neural tube defects. Additionally, important items to look for are iron (to help with red blood cell formation, ideally at least 18mg in a prenatal), Vitamin D3 (at least 600 IU) and calcium for bone health, choline (to help with brain and spinal cord formation), Vitamins A, C, B6 and B12.
2- Is it ok to be on birth control pills for 10 or 20+ years?
Yes. Being on oral contraceptives for at least 5 years cuts your risk of ovarian cancer in half. In addition, birth control pills help to decrease your risk for uterine cancer, regulate your cycle, prevent anemia, relieve symptoms of PMS and PMDD, and help with endometriosis and menstrual migraines.
Evolutionarily, before women had the ability to control when they became pregnant, a woman might be pregnant or breastfeeding (suppressing ovulation and menstruation) for the majority of her reproductive life – from 15 to 45. Thus being on birth control pills and preventing ovulation is, in some ways, “more natural” than having a cycle every month.
3- Do I have to wait 6 weeks after giving birth to have sex and/or exercise?
Both questions are different and depend on the individual woman and her unique medical circumstances, obstetric history, birth history, and preference. Women who give birth vaginally and have little to no complications (no or minimal tearing of the vagina, perineum, and external + internal anal sphincters, can resume sex sooner than 6 weeks, and studies show many women do resume intercourse prior to 6 weeks. Having said that, your obstetrician or midwife knows you and your history best, so may want to check with her/him just to be 100% certain. If you had a cesarean delivery the same rules regarding sex apply.
As far as exercise, again, the advice is individualized. For nearly 100% of women, walking is actually recommended following delivery and helps with healing, circulation, mood and sleep. If you had no complications with your delivery and your doctor clears you to resume more vigorous exercise, you may resume exercise prior to 6 weeks. If you had a cesarean, there are exercises you can do, but you should check with your obstetrician or midwife first. Bottom line, walking with your new baby is recommended, more strenuous activities should be cleared by someone who knows your medical and obstetrical history.
4- What can be done during labor and delivery to minimize vaginal tearing?
Some tearing is unavoidable, but having an epidural often allows women to push slowly at the very end of delivery, so as not to cause any sudden movements of the baby, which can result in the baby “popping” through the perineal wall and causing tears. Warm compresses can help. Sometimes, as an obstetrician, I try very hard to control the speed of the baby’s head, again, so the delivery is smooth and without sudden movement. Having said that, if a mom needs to push, absolutely, she needs to push.
First-time moms in my care often have no tear, a 1st degree (vaginal tissue) tear, or a 2nd degree (perineal tissue). The two other types of tears are 3rd degree (tearing through the external anal sphincter) and 4th degree (tearing through the internal anal sphincter).
Just because you have a tear, doesn’t automatically mean you need stitches. Moms with 1st degree tears often do fine without stitches. In 20 years of practicing obstetrics, I’ve only had one 4th degree tear and I work solely on L&D, as an OB Hospitalist. Squatting, as a birth position, has been shown to increase the risk of tears, whereas laying on your back or side, decreases.
If the baby’s fetal heart rate is “down” and your ObGyn is worried about sufficient fetal oxygenation, it might be that she/he recommends an operative delivery with vacuum or forceps to prevent any injury to the fetal brain, in which case they might cut an episiotomy. If I do cut an episiotomy, I make it a mediolateral one (off to the side). This type of episiotomy has been shown to lower the risk of a mom tearing through the external and internal anal sphincters (which can lead to fecal incontinence, leakage of farts and/or poop). However, this type of episiotomy has been shown to have more pain in the recovery phase.
If you want to know what your doctor’s thoughts are regarding tearing, just ask. Most obstetricians know that “routine” episiotomy is a relic, but – being 100% honest – I still see some doctors doing this. Make sure you have a conversation with your obstetrician ahead of time to ensure that you align on values.
5- Can I get pregnant while breastfeeding?
Yes, you can. There is literally no method of contraception that is 100%, including breastfeeding.
If you are breastfeeding exclusively, meaning not giving any infant formula, then studies show that your risk of getting pregnant within the first 6 months following delivery of your infant is around 1-2% (if after 6 months if you don’t want to get pregnant, you need a different form of birth control). In order for exclusive breastfeeding (or lactation amenorrhea) to work, you can’t introduce formula or solids, you should nurse on demand at least every 4 hours during the day and every 6 hours at night, avoid pacifiers and pumping.
Jane Van Dis, board certified obstetrician/gynecologist and Bobbie Medical Advisor.