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Baby on Board
Travelling while you're pregnant

Congratulations are in order! It is an exciting event when you and your partner find out you are pregnant. Many questions may go through your mind. Love and sexuality created this situation, so it is not surprising that you may want to continue this expression of intimacy.

Travel to distant and interesting places has become relatively simple. Many of us begin planning the next vacation as soon as we return home from the last one. Business travel also takes us far from home. If you are pregnant, you can be part of this wave of travellers. Still, remain aware of certain precautions and limitations.

If your pregnancy is low risk, reasonable travel should not be a problem. The safest time to travel in pregnancy is during the second trimester, the fourth to sixth months of pregnancy. During these three months, your body has adjusted to pregnancy but is not yet too uncomfortable for travel. The risk of miscarriage or early labour is also lower during this time.

A brief trip to a developed country is much safer than travelling in a developing country. In developing countries, you may be far from expert medical and pregnancy care. You are also more likely to be exposed to serious disease that could affect you and your baby. Wait to travel to these parts of the world until after the baby is born.

Assessment before travel

If you wish to travel any distance while pregnant, discuss your plans with your doctor. Your doctor can consider your stage of pregnancy and potential risks before advising you about safe travel plans. This may include safe strategies during travel and appropriate use or avoidance of medications during your trip.
Certain symptoms suggest you need emergency care, including:

• bleeding from the vagina (birth canal)
• low abdominal pains, cramps, or contractions
• a gush of fluid from the vagina
• headaches, blurred vision, ankle swelling or high blood pressure.

All travellers need to carry medical information. List your blood type, any medical conditions, and the name and number of your doctor. Ask yourself what you would do in an emergency and plan accordingly before you leave.

Travel clinics are good resources for advice on preventing illness on the road, and can provide a list of qualified medical personnel in different countries. The International Association for Medical Assistance to Travellers (IAMAT) can provide a list of qualified English-speaking doctors in different countries (www.iamat.org or phone 519-836-0102).

Travel insurance

When travelling, you cannot rely on your provincial health insurance plan to provide the same level of coverage. Anyone travelling, especially to less developed countries, should buy travel and health insurance with a world-wide, 24-hour medical advice number. Since many policies do not cover pregnancy complications, delivery or care of a newborn, compare various policies and read the exclusions before buying insurance.

Air travel

Most airlines allow pregnant women to travel until 36 weeks of pregnancy. After this point, air travel is not advised because air pressure in the cabin can cause problems with oxygen delivery to the baby. There is also the possibility of labour and delivery while in the air.

Women with medical complications of pregnancy should not travel by air. These include a twin pregnancy, high blood pressure, extreme nausea, poorly controlled diabetes, or problems with the placenta. (Your unborn baby receives oxygen and nutrients through the placenta.)

Remain aware of certain concerns when flying:

• A blood clot in the leg (called a deep vein thrombosis or DVT) can develop during air travel. Changes in blood clotting that occur during pregnancy, dilation (widening) of the leg veins, and keeping your legs inactive make this a possibility. To reduce this risk, walk about the cabin often (at least every two to three hours), stretch or do isometric (muscle clenching) leg exercises while sitting. Support socks or hose also help reduce the risk of blood clots in the legs while travelling.
• Dehydration is possible, partly because of decreased humidity in the airplane. Keep your fluid level up by drinking beverages that have no caffeine or alcohol.
• Using seatbelts incorrectly can also cause problems. Wear your seatbelt low around the pelvic bone, for most of the flight.

Although many pregnant women are concerned about security scanning, metal detectors cause no harm to the developing baby.

Motor vehicle travel

Blood clots in the legs are also a concern during travel in a motor vehicle. As with air travel, you should stop, get out and walk for a few minutes at least every two to three hours. Do not travel more than six hours a day.
Motor vehicle collisions are the main cause of injury to pregnant women. Seat belts are very important, especially when pregnant. If she is thrown from a vehicle, the pregnant mother’s risk of dying increases six fold while her baby’s risk increases five fold. Wear a combination lap and shoulder belt whenever travelling in a vehicle.

Sea voyage

Nausea and vomiting are more likely during travel on a boat, especially during the first three months of the pregnancy. Certain medications and precautions that are safe to use in pregnancy can help decrease this possibility.

Your balance is also affected while you are on a boat. You may be unsteady on your feet and so more at risk of falling. As a rule, cruise lines do not usually accept pregnant travellers beyond 32 weeks of pregnancy.

Immunization

Several vaccinations are available for travellers going to areas affected by disease. Again, if you may be exposed to potential harm or illness during a trip, it is worth waiting until after delivery to travel. If this is not possible, consult your doctor and the travel clinic about your vaccinations several months before departure. If you will be in an area where malaria is common, precautions include anti-malaria medications approved for use in pregnancy along with avoiding mosquito bites.

Drugs and pregnancy

So many drugs are unsafe during pregnancy that they cannot all be listed here. However, some common medications should be avoided during pregnancy, whether travelling or not. For further information about the safety of medications in pregnancy, look the drugs up at www.motherisk.org or talk to your doctor.

Avoid the following drugs:

• ASA or acetylsalicylic acid (Aspirin™) increases the risk of bleeding and can make labour longer.
• Ibuprofen (Advil™, Motrin™), naproxen (Naprosyn™), and other nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of bleeding and cause problems with the baby’s kidneys and heart.
• Pepto Bismol™ (bismuth subsalicylate) contains ASA and can increase the risk of bleeding.
• Alcohol in any amount can cause problems with the developing baby.
• Any medication in a foreign country, if it may have been tampered with or you are unsure of what it may contain.
• Acetaminophen (Tylenol™) and penicillin are safe during pregnancy when taken as directed.

Exercise

The American College of Obstetricians and Gynecologists (ACOG) recommends the following exercise guidelines for any pregnant woman.

• Maternal heart rate should not exceed 140 beats per minute.
• Limit strenuous activity to a maximum of 15 minutes.
• Avoid increased body temperature.
• After 16 weeks of pregnancy do not exercise while lying flat on the back.

Other activities may appeal to you while you are traveling. Still, be aware of the risks.

• No scuba diving at any depth. Snorkelling is safe if you are an experienced swimmer.
• No water skiing or activities with a major risk of trauma. Caution is advised with skiing, hiking and horseback riding.
• Make certain you do not overheat, dehydrate or overexert yourself.

Diarrhea

Twenty to 70 per cent of visitors to developing countries experience travellers’ diarrhea. The risk is higher for pregnant women. Diarrhea in pregnancy can be very serious. You can become severely dehydrated if you cannot replace fluids that are being lost from diarrhea.

To prevent diarrhea, be very careful about what you eat and drink.* Drink only bottled water, water that has been boiled for at least 15 minutes, or that has been chemically treated to rid it of bacteria and parasites. If diarrhea develops, the most important thing to do is to drink a lot of liquids to replace the fluid being lost. Oral rehydration solutions and intravenous fluids may be needed to treat dehydration. Some medications, including loperamide (Imodium™) are helpful and safe for treating diarrhea during pregnancy. Again, talk to your doctor about this before you travel.

In general, if you are a healthy woman with a normal, low-risk pregnancy, you need not be limited from regular travel. If you have other health issues or a complicated pregnancy, travel may not be recommended.

* Follow the recommendations given here and the following article to help ensure a safe and healthy trip. Above all, be careful about what you eat and drink wherever you travel, and avoid areas with diseases that could be harmful to you or your unborn baby.