Travelling Abroad in Pregnancy

Travel During Pregnancy

With a sensible approach and a little planning there is no reason why most pregnant women can’t enjoy the benefits of travel and holidays. Experts tend to agree that the second trimester is the safest time to travel. This is also the time (around 12 to 24 weeks) when any discomfort should be at a minimum. In the first trimester there are potential issues with such things as morning sickness and the risks of miscarriage being greater at this time. In the third trimester a less manageable bump, swollen ankles and the possibility of a premature birth are the more relevant concerns.

Points to Consider

Flying When Pregnant

You may find that policies on pregnant women differ from airline to airline. The governments “yellow book” on health information for overseas travel states that airlines will usually allow women up to 36 weeks pregnant, without complications, on their flights. Other sources say many are unwilling to carry women more than 32 weeks pregnant. There may be a requirement for a doctor’s letter, containing details and assurances, for women over 28 weeks pregnant. It is best to find out from the airline concerned how their policies might affect you.

The IATA (International Air Transport Association) guidelines clarify these issues to a degree, stating the 32 week cut off point as being for multiple pregnancies. Do not forget to consider how many weeks pregnant you will be on the return journey of your planned trip. Airlines tend not to allow pregnant women with histories of previous premature births, or deep vein thrombosis on their flights.

There is no need for concern over whether security screening machines at airports will affect your unborn baby, as these machines are metal detectors and not x-ray devices as used on luggage. Be aware of the controlled humidity on aircraft, which is set at 8%. Drink plenty of fluid to combat dehydration.

Pregnancy Flying and Thrombosis

Due to changes in hormones and blood pressure (the latter especially in late pregnancy), the risk of thrombosis in pregnant women is increased substantially. With this in mind, it is important to take precautions when travelling by any method where there are potentially long periods of inactivity. Walking and leg exercises, Fluid intake (not alcohol) and the wearing of flight socks are all good steps toward helping to combat thrombosis. Aspirin has no proven benefit in this regard, and could prove to be a problem with essential blood clotting if there was an unexpected ante partum haemorrhage. It should therefore not be taken.

Foreign Facilities and Care for Pregnancy

It is very important to know in advance the type of facilities and level of care available for pregnant women in any foreign country you plan to visit. The foreign and commonwealth office has information on health care standards in different countries on its website which can be found at http://www.fco.gov.uk/

Look under services, travel advice, travel advice by country then select a country.

Insurance for Pregnant Women Flying

It may well be necessary to have some form of medical insurance in place in the event of the need for treatment abroad. The department of health has information on which countries do have a reciprocal health care arrangement with the UK. They also have information on the EHIC (European Health Insurance Card), which has taken over from the old E111 travel health care form. Their website is http://www.dh.gov.uk/ Insurance companies may differ from one to the other in their approach toward pregnant women. Some may require a “pre-travel health statement” from your GP, many do not insure for maternity care and medical assistance from the start of the ninth month of pregnancy. Your travel agent may have more details.

Vaccinations For Pregnant Women

It is best not to travel to countries which require vaccinations if you are pregnant. Live vaccines are not given to pregnant women as a general rule. Countries which require visitors to be immunised against yellow fever, for instance, will probably need a certificate of exemption to be produced to gain entry. Consult a doctor about any specific issues.

Malaria & Pregnancy

As in the case of vaccinations, it is best not to travel to any country where there is a risk of contracting malaria. If you must go to a malarious region then the use of chemoprophylaxis (drugs taken to try to prevent malaria) in the form of chloroquine and proguanil are said to be safe for pregnant women. In regions where strains are resistant to these drugs, doctors may be more cautious about the less well researched alternatives. Speak to a doctor if considering visiting malarious regions while pregnant.

Unsafe Vaccinations for Pregnancy

The obvious unsafe activities are the energetic sports which you may have enjoyed prior to becoming pregnant. Things like skiing, surfing, snowboarding and anything that involves a risk of falling should be avoided. Sudden jolts of acceleration and deceleration as experienced in, for example, amusement park rides, could also harm the baby. A less obvious hazard is scuba diving. The air bubbles which can form in the bloodstream, upon surfacing from a scuba dive, can be very harmful to mother and unborn baby alike.

Care should be taken to avoid high places where there could be a possibility of altitude sickness. This will not pose any problem in the safe, controlled pressurized atmosphere of the airplane flight.

Lastly, evidence from some studies has indicated that a raised temperature in early pregnancy, such as that which arises from indulging in saunas and Jacuzzis, could mean an increased risk of birth defects.

Sunbathing when Pregnant

Ultraviolet rays from the sun can have a damaging effect on the human body. Skin cancer, premature aging of the skin and possible eye damage are potential outcomes of too much exposure to strong sunlight. During pregnancy a woman may find her skin more sensitized than usual to the rays of the sun (or sun beds for that matter). Some women experience dark patches on the face known as chloasma or pregnancy mask. This can be an indication that the skin is more prone to react to the sun, and the condition may well worsen with continued exposure.

Any effects that ultraviolet rays may have on an unborn baby are not really known, though there are concerns that a connection may exist between UV rays and a deficiency in folic acid. Folic acid plays an important role in a baby’s neural system development in the first trimester. The safest option is to avoid too much exposure to the sun, especially while pregnant.

Check List for Pregnancy Travel

Confirm with your doctor or midwife that travel is a safe option for your particular pregnancy and stage of pregnancy. Ask your doctor if there are any prenatal care checks and visits that should be attended to in the time period that you are away, and what should be done about them.

Take with you a record of your blood type, and a copy of your pregnancy records.

Look into the standard of care and medical facilities at the place you are planning to visit. Ensure that they are familiar with how to handle complications etc if travelling during the third trimester. Familiarise yourself with the locations of hospitals and clinics.

Ensure you are well covered. Valid health insurance, medical evacuation policy, supplemental travel policy and a policy that covers the baby if it ends up being born abroad. Contact a broker and ask about all these points. Check that the airline knows your circumstance and there are no issues with them over it.

Check that there is safe food and drink such as bottled water at the place you plan to visit.

Take approved medicines with you for typical pregnancy symptoms like constipation or heartburn. Be aware that certain travel sickness treatments may not be suitable for pregnant women. Anything containing hyoscine hydrobromide as found in Kwells is not recommended for pregnant women. Sea bands and ginger may be worth investigating, and ask your doctor about any other alternative treatment if you are concerned about travel sickness. Thrush is a condition that is exacerbated by both pregnancy, and hot, humid climates. Pack loose cotton clothing to wear, and any prescribed or doctor recommended anti fungal treatments. Take some blister pads and enough practical shoes if you plan to do a lot of walking. Diarrhea is a common issue with traveling abroad. Some medicines (e.g. loperamide, as found in Imodium) are not to be taken while pregnant. Ask your doctor for further advice.

Tips For the Pregnant traveller

Other things that may prove useful when planning to undertake a journey are:

Conserving energy. Especially relevant for the hitherto adventure holidayer. Action woman must learn to slow down and pace herself now she is pregnant. Ensure that the holiday itinerary is not jam packed with activities. Plan some quiet, relaxing time in there.
Healthy eating. It may be more difficult to have as much control over this as you would wish if travelling abroad. It is important to have plenty of protein, fresh fruit and vegetables. If there could be a problem with the availability of these, speak with your doctor about vitamin supplements etc. Remember to drink plenty of bottled water, and have close to hand, snacks like cereal bars, dried fruit and nuts. If you experience difficulty eating large meals, try frequent small meals.
Stress reduction. Expect worst case scenarios in the case of flight delays for example. Factor in plenty of time to cater for traffic problems and such like. Let the chaos pass you by immersed in a good book, or favourite song on the mp3 player, secure in the Knowledge that you’ve done all you can.
Toilet breaks. Being pregnant you may find yourself needing to go to the toilet much more than usual. Plenty of forward planning should help with this and make you feel more secure about the forthcoming journey. Try to anticipate the availability, condition of, and your frequency of need for toilet facilities. From motorway services and airport terminals, to securing aisle seats on planes, trains etc. Pelvic floor exercises can help greatly with urinary control, and incontinence pads can be a reassuring last line of defence.