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Today TPG Contributor Jason Steele offers advice for pregnant travelers, including medical concerns, logistical considerations and more for those who are traveling for two.
For frequent travelers, nine months is a long time to stay at home. So its no wonder that many women (and their families) are interested in learning about traveling during pregnancy. Although my wife and I traveled while she was pregnant with each of our two daughters, I reached out to my friend Dr. Andrew Ross at Mountain Vista OBGYN and Midwifery in Denver for some qualified medical advice. (Of course, women who are pregnant should always consult their own doctor.)
Pregnancy and air travel
Dr. Ross first directed me to a committee opinion of the American Congress of Obstetrics and Gynecology (ACOG), that says quite plainly, “In the absence of obstetric or medical complications, pregnant women can observe the same precautions for air travel as the general population and can fly safely.”
The guidelines then note that “Pregnant women should be instructed to continuously use their seat belts while seated, as should all air travelers.” Dr. Ross cautioned me that many women are under the mistaken impression that the seat belt will potentially harm their child in the event of an accident. When properly worn, the seat belt rests on the pelvis and safely below the fetus. Furthermore, the risk to the mother and child is far greater when not wearing a seat belt. This advice applies even more emphatically to car travel, which is far more dangerous than commercial air travel.
Another concern for pregnant women is a condition called venous thrombosis, which is a blood clot that forms in the veins. This is a risk for all air travelers due to long hours in a seat combined with low cabin pressure and low humidity, but pregnant travelers are at an even greater risk. Therefore, it’s important to stay hydrated and to try to get up and move around from time to time, rather than remain seated throughout the flight. Staying properly hydrated also reduces the risks of premature labor. Dr. Ross also recommends trying compression socks, which are commonly available.
A much more remote danger is that posed by cosmic radiation during the very first few weeks of pregnancy. Since the Earth’s atmosphere protects us from cosmic radiation, and commercial jetliners fly above most of the atmosphere, passengers and crew receive a much higher exposure than those on the ground. In fact, flight attendants are known to have the highest normal exposure to radiation of any occupation.
Thankfully, the risks are very low and there are no current prohibitions on flight crew who are pregnant. Exposure is highest over polar routes during the winter, but unless you’re planning on taking many long flights early in your pregnancy, the risks are not considered to be statistically significant. To put this in perspective, the longest flights result in exposure that represents just 15% of the recommended limits.
Other safety considerations during travel
Pregnant travelers should be more concerned than normal about food borne illnesses, so examine the hygiene practices of the country you’re visiting, and take extra precautions to avoid exposure to harmful parasites. Dr. Ross also does not recommend that pregnant women travel in the final month of their pregnancy, simply because of the risk of delivering on an airplane in the absence of medical care.
Beyond that, Dr. Ross cautions that pregnant women should avoid waterskiing, jetskiing, and other impact sports, although he recalls writing a note to allow a patient of his to swim with dolphins. So, yes to cross country skiing, as I did with one of my sisters five months into her last pregnancy, but no to the dangers of downhill skiing. Otherwise, Dr. Ross informed me that pregnant women are usually free to participate in most of the same exercise and activities that they enjoyed prior to pregnancy, but should not begin any new ones until after their baby is born.
Since the greatest danger of flying while pregnant is from an airborne delivery, some airlines have rules for traveling while pregnant during the ninth month.
American: For domestic travel, not including over-water flights, no travel is permitted within 7 days before or after delivery or due date without a medical certificate. Internationally, or over water, travel is not advised within 30 days of the due date, unless you are examined by an obstetrician within 48 hours of outbound departure and certified in writing as medically stable for flight. Travel within 10 days of the due date for international travel requires clearance from the airline’s Special Assistance Coordinators, as does travel within 7 days after delivery.
Hawaiian: Hawaiian Airlines will not transport a passenger expecting delivery within 7 days. Exceptions can be made with a doctor’s certificate dated within 72 hours of departure stating that the passenger has been examined and found to be physically fit for transportation, and will not require any extraordinary medical attention during the flight. However, if Hawaiian Airlines feels that the passenger does not seem fit to fly on the departure date, the decision to accept the passenger will be made only after medical personnel are contacted, and the passenger is examined and cleared to fly.
Jetblue: Pregnant Passengers expecting delivery within seven days are prohibited from travel, unless the passenger provides a doctor’s certificate dated no more than 72 hours prior to departure stating that the Doctor has examined and found the Passenger to be physically fit for air travel to and from the destinations requested on the date of the flight, and that the estimated date of delivery is after the date of the last flight.
United: A woman traveling during her ninth month of pregnancy must have the original and two copies of an obstetrician’s certificate, which must be dated within 72 hours of her flight departure (within 24 hours is preferable). The certificate must state that the obstetrician has examined the customer and found her to be physically fit for air travel between the specified dates. The estimated birth date of the baby must be after the date of the last flight on the itinerary. The customer should provide the original certificate to a United Representative at check-in. The remaining copies are for reference during air travel.
US Airways:If your due date is within 7 days of your flight, you must provide a doctor’s certificate, dated within 72 hours of departure, stating that he or she has examined you and determined that you are fit to fly. Note that American’s rules also apply if any flight is operated by American.
Virgin America: Virgin America will allow a woman to travel without a doctor’s permission up to seven days before her due date. Any woman who is within seven days of her due date must submit a document from her physician on official letterhead stating that she is fit to fly. This information must be available to a Virgin America Team Member at check-in. For roundtrip flights, the document must indicate that the passenger will be fit for the return portion of her trip as well.
Alaska, Delta, Frontier have no restrictions, but they each recommend consulting your doctor first.
With safety concerns and airline rules addressed, pregnant travelers and their families will be most concerned with comfort. Interestingly, the first and third trimesters seem to present the most challenges when it comes to a pregnant woman’s comfort during travel. A prevalent issue for pregnant travelers is morning sickness, which commonly includes nausea and other symptoms that can be exacerbated by motion.
Dr. Ross recommends that pregnant women women should avoid gas-producing foods and drinks (such as carbonated beverages) before flights. The ACOG guidelines also indicate that “Preventive anti-emetic medication should be considered for women with increased nausea.” So once again, talk to your doctor.
While there are no guidelines specifically for traveling to high altitude regions, Dr. Ross notes that pregnant women who visit higher elevations have an increased chance of pre-term contractions, which can be uncomfortable. This should certainly be a consideration for those who are considering a trip to mountainous areas during their third trimester.
Advice from women
I spoke to several women (including my wife) who have experience traveling during their pregnancies. Here are some of the insights they offered:
1. Every women and every pregnancy is different. A common observation by the women I spoke with was that their experiences differed not only from those of other women, but that each of their own pregnancies was unique. So while some women might have few symptoms of morning sickness or other discomfort, others may be surprised by the intensity their symptoms. The consensus was that you shouldn’t assume your next pregnancy will be the same as your mother’s, your sister’s, or even your own.
2. Frequent need to use the bathroom is common. This is especially true when you follow your doctor’s advice and stay well hydrated. The women I spoke to recommended choosing an aisle seat near the bathroom and avoiding any other situations where you might not have quick access to the restroom.
3. Travel, but not too far. Medical practices in foreign countries can differ substantially from those at home, and staying within the United States allows you to access the same prescription and over the counter medications, should your doctor recommend them. The women I spoke to who traveled while pregnant felt more comfortable staying within a few hours reach of their home town on a non-stop flight, should they wish to cut their trip short.
For example, one of my sisters traveled from Atlanta to Denver for my wedding during her ninth month, but chose to depart early the next morning when she experienced some pre-term contractions, possibly due to the higher elevation. Her healthy daughter was born 10 days later.
4. Travel during the second trimester. With the first and third trimesters being the least comfortable, the second trimester seems to be the best time to travel. During the second trimester of my wife’s first pregnancy, we spent a relaxing weekend in Las Vegas, while during her second pregnancy, the three of us took a train from Seattle to Los Angeles. We all enjoyed both trips and had no regrets.
5. Have a comfortable backup plan. Travel can be stressful and exhausting under normal conditions, so the pregnant women I spoke to and their families highlighted the need to have a backup plan to avoid the worst of it. That means being prepared to cancel a trip if you don’t feel up to it, or having a predetermined course of action should your travel plans fall apart. For example, you might go out of your way to avoid connecting flights, and not book the last flight of the day. It’s also a good idea to determine in advance a comfortable place to spend the night if your flight is severely delayed or cancelled. Packing extra water and healthy snacks is another great idea.
6. Bring along a copy of your medical records. To be extra cautious, you might want to carry a copy of your medical records, especially if you have had any complications or an unusual medical history. This will make it a lot easier for everyone should you need to see a doctor in another city.
Have you traveled while pregnant (or with someone who was)? Please share your tips and experiences in the comments below.
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