Ryan Elizabeth Offer, MD, is an obstetrician and gynecologist at Drexel Medicine. She provides routine gynecological care, prenatal care, minimally invasive gynecological surgery, and labor and delivery care. Dr. Offer is also an assistant professor at Drexel University College of Medicine.
Can you tell me a little bit about yourself and what got you interested in medicine?
I am the second of five girls, and I grew up in northern New Jersey. I currently live with my husband, my twin girls and son just outside of Philadelphia. I knew I wanted to be a physician since I was around 10 years old. Always being around women and the idea of delivering babies intrigued me, which led me to become an obstetrician gynecologist.
I graduated from UMDNJ—New Jersey Medical School in Newark, New Jersey, which is now called Rutgers Medical School. After that, I came to Drexel for my OB/GYN residency. From the moment I went on my first interview at Drexel, I felt welcomed and comfortable here. I finished my residency in 2008 and I stayed on to join the practice at Drexel.
Where do you see patients?
I see patients at our Rittenhouse and Manayunk locations.
As a Drexel OB/GYN, what services do you provide to your patients?
As an obstetrician, in addition to labor and delivery, I provide everything from routine prenatal care to high-risk obstetrical care. As a gynecologist, I take care of patients from early adolescence to women in their 90s. This includes routine annual exams, where we address everything from reproductive health and contraceptive issues, to gynecologic conditions that require surgery.
How often should a woman get a Pap smear?
For years it was recommended that patients should get an annual Pap smear to screen for cervical cancer. In 2012 this recommendation was changed, resulting in less frequent screening. Screening is based on the patient's age and her prior Pap smear history. The change in the screening interval has helped to decrease the rate of false positive results, which can expose patients to undo stress and over treatment.
However, it's important for patients to know that just because you don't need an annual Pap smear, you should still see your gynecologist once a year. There is a lot that is covered in an annual exam, besides a Pap smear. Depending on your stage of life, you may want to discuss contraception, sexually transmitted infections, pre-conception health, or menopausal issues. We also perform a physical exam, which includes a breast examination and pelvic examination to evaluate for other possible medical issues or cancers.
What should a woman look for in an obstetrician?
If you have a good relationship with your gynecologist and he/she practices obstetrics, then the natural path is to continue your care with that doctor. In general, women should look at the type of practice. For example, they should consider the size of the practice and ask who will actually perform the delivery. Does the practice have midwives? At Drexel, for example, we have the privilege of working closely with our midwives as one practice. What is the cesarean section rate? Hahnemann University Hospital where our practice delivers has the lowest caesarean rate in the city. What level of nursery does the hospital have? If there's a potential medical issue with the baby, can the baby stay at the hospital where they're born or will the baby have to be transferred to another hospital? These are some of the things a woman should consider.
Is there still a concern about Zika virus and pregnancy?
There is definitely still a concern with Zika. If you're thinking about getting pregnant or if you're already pregnant, we recommend not traveling to any area with active Zika virus transmission. You can check the CDC website for the most up-to-date information about those areas.
If you do travel to one of those areas, we suggest waiting at least six months if you decide you want to get pregnant. It's important to remember that males can carry the virus in sperm as well. It can be sexually transmitted from a partner who has travelled to an area with Zika even if the woman has not travelled there.
If you are pregnant and have to go to an area where they have found Zika transmission, you should avoid being outside. You should also stay in air conditioning with closed windows, especially during daytime hours when the Zika-carrying mosquitoes are most active. If there is no air conditioning, you should use a mosquito net. You should also use bug spray and get clothing that's treated with permethrin to try and decrease your chances of getting mosquito bites.
What is the normal amount of weight gain you recommend for a pregnancy?
We base our recommendations on a woman's body mass index (BMI), which is determined by her height and weight. For women with a normal weight, which is a BMI between 19 and 25, we recommend a weight gain between 25 and 35 pounds for the pregnancy. If a patient is overweight, we recommend 11 to 20 pounds of weight gain. For a severely obese woman, we recommend against any weight gain.
I'm personally not a big stickler on weight, though. People react differently to being pregnant. I just try to remind women that while they should eat more for the baby, they don't need to eat for two. In the first trimester, you only need to add 100 calories to your diet. In the second trimester, we bump it up to 200 calories and in the third we recommend 300 calories, which is a little more than an extra granola bar a day.
Is it okay to exercise while pregnant?
Exercise is encouraged. WHO (World Health Organization) recommends 150 minutes of moderate exercise per week. If you were a runner or really into exercising before pregnancy, we encourage you to continue that exercise routine. However, if you're bleeding or cramping, you may need to decrease the intensity. Also, some women may have issues or develop issues, such as elevated blood pressure, preterm labor or placental problems that may preclude them from exercising. If this occurs, we will recommend that you back off or stop exercising. All in all, exercise is good for mom and for baby.
What about caffeine?
Everything in moderation. High doses of caffeine in the first trimester have been associated with miscarriage, so if you're a big coffee drinker, you will need to cut down. You don't need to go completely cold turkey, though. I tell patients that one eight-ounce cup of coffee—your grandmother's cup of coffee, not a huge cup from the local corner store—is fine during the first trimester. In the second trimester and beyond, two cups a day is fine. Unfortunately, many women think they need to cut it out completely and they end up with a raging headache. To treat those types of headaches we'd suggest a pain reliever such as acetaminophen with a little caffeine. It's not necessary to cut caffeine out entirely.
How do you determine if it will be a natural birth or a Caesarean section?
We take a “healthy mom, healthy baby” approach. As long as mom and baby are healthy, it doesn't necessarily matter how you have the child. That being said, every pregnant woman should have the opportunity to attempt a vaginal delivery, with some exceptions. Occasionally a C-section is necessary, for the baby and or the mother's safety.
Reasons you would have to undergo C-section without attempting a natural birth, include fetal indications such mal-presentation (i.e. breech baby), problems with the placenta (i.e. placenta previa), having a prior C-section and declining to attempt a vaginal delivery. There are also reasons that we would do a C-section once a woman is in labor, for example if a baby is not tolerating the contractions, the baby is too big to fit or the cervix will not dilate all the way.
A C-section is a major operation, so we don't do it electively, which is reflected in our low C-section rate. Drexel OB/GYN has the lowest rate of C-sections in the city and the second lowest in the state.
What do you like most about working at Drexel?
The people. The physicians, midwives, office staff, nurses, I love everyone that I work with. When you walk into our office, you get off the elevator and you immediately feel welcomed. As a patient, it can be uncomfortable walking into a gynecology office, but everyone here is very knowledgeable, polite and friendly, so I think that eases a lot of the anxiety a woman may feel. We do everything we can to accommodate each individual patient's needs and address her concerns. It helps having a diverse group of physicians that work well as a team allowing us to deliver the best possible care.