You'd be hard-pressed to find an Ob-Gyn who would sanction unnecessary travel late in one's pregnancy. In fact, most doctors will tell you that the ideal time to travel is during your second trimester. That's typically when you'll feel your best, have the most energy, and the risk for complications is relatively low.
Of course, it's not that you shouldn't travel during the first trimester, but nausea and fatigue can often make it uncomfortable. Miscarriages are also more likely to occur during the first trimester. "Air travel doesn't cause miscarriage, but women who miscarry when they travel have a hard time believing it's not their fault," says Pamela Berens, M.D., associate professor of obstetrics and gynecology at the University of Texas, in Houston.
And once you reach your third trimester, obstetricians prefer you stay closer to home, just in case there's a sudden, unexpected complication...or your baby decides to make an early appearance. "All Ob-Gyns agree with not traveling after 36 weeks, and many would argue that you probably shouldn't travel beyond 34 weeks," says William Rayburn, M.D., chair of the obstetrics and gynecology department at the University of New Mexico, in Albuquerque.
If you have a high risk pregnancy, Ob-Gyns are even more cautious. Edward Lazarus, M.D., assistant professor of obstetrics and gynecology at the University of Tennessee Health Science Center, in Memphis, recommends that high-risk patients stay put after 24 to 28 weeks. Women who have medical or obstetrical complications – such as pregnancy-induced hypertension, poorly controlled diabetes, sickle-cell disease, or other conditions that could result in an emergency medical situation – are encouraged not to fly. Women who are at significant risk for premature labor, those with an incompetent cervix, or those with placental abnormalities such as placenta previa should also stay on the ground.
Also of concern are women with certain medical conditions unrelated to their pregnancies. For example, because low cabin humidity and changes in cabin pressure may result in an increased heart rate, people with heart disease may experience increased blood pressure and difficulty breathing. While several U.S. airlines allow women to fly at any time during pregnancy, some require a doctor’s note after 36 weeks. That’s because airlines want to avoid women going into labor on board.
The stakes are also higher with multiples. "If you're carrying twins, or more, you probably should not travel after 20 weeks," Dr. Lazarus says. Women with multiple pregnancies have a higher risk for preterm labor and C-section delivery, as well as other health ailments.
If you must travel during pregnancy, here's what you need to know to stay safe and comfortable.
Get your Ob-Gyn’s permission. Before you travel, make sure your pregnancy is progressing without complications. If you're late in your second trimester, have an ultrasound to determine that the placenta isn't covering the cervix (a condition called placenta previa, which occurs in fewer than 1 percent of births). "You may not have had any trouble with your pregnancy, and then you reach 27 weeks and begin hemorrhaging," says Dr. Lazarus, who still vividly remembers when his wife began hemorrhaging from a placenta previa at 2 a.m. – while they were in Yellowstone National Park.
Dicuss your mode of transportation. Airport security checkpoints and jets' pressurized cabins pose no dangers to pregnant women, and motion sickness (in a car or on a boat) is unlikely to worsen just because you're pregnant. However, your doctor may recommend skipping cruises: Norwalk virus, a common cause of vomiting and diarrhea that's spread by poor bathroom hygiene, proliferates aboard ships. "You can get sick and dehydrated pretty quickly," warns Dr. Lazarus. "The baby wouldn't be at risk, but you'd be miserable."
Consult a travel-medicine specialist. If you're planning a jaunt to less-developed regions, see a doctor or nurse practitioner who has travel-medicine expertise about food and water safety precautions, endemic diseases, and requisite vaccinations, advises Kip Baggett, M.D., medical epidemiologist in the travelers' health section of the Centers for Disease Control and Prevention, in Atlanta (to find a travel health specialist near you, go to www.cdc.gov/travel/travel_clinics.htm). The general rule on vaccinations is that killed virus vaccines, like Hepatitis A or flu shots, are safe during pregnancy. Live virus vaccines, such as yellow fever or tuberculosis, are not safe since they contain small amounts of the weakened virus. (For more info on vaccinations, go to www.cdc.gov/travel/vaccinat.htm.) If the risks for both the disease and the vaccinations are too great, your Ob-Gyn will recommend you rethink your travel plans.
Call your airline. Surprisingly, airlines don't have consistent rules about when pregnant women can fly, so check your carrier's policy before buying any non-refundable tickets. You may also need a note from your Ob-Gyn stating your due date and verifying that you're fit for travel.
Pack a copy of your prenatal record. It has information about your due date, blood type, blood pressure, and ultrasound results. "If you need to go to an emergency room in a different city, having your record on hand can save you extra phone calls as well as blood work and ultrasounds. Plus, your prenatal record can help ensure that you get the critical care you need sooner," says Susan Warhus, M.D., author of The Countdown to Baby (Addicus Books).
Check your health insurance. Make sure your policy covers emergency care when traveling abroad. Note that some companies allow you to purchase additional travel policies that cover you and your baby, should you deliver out of state or in another country.
Find an alternate Ob-Gyn. Prior to leaving for her trip, Pamela Waldrop Shaw made arrangements with a Dallas Ob-Gyn to deliver her baby if she went into labor at her conference. It's a good idea to have the name and number of another Ob-Gyn if you get into trouble in a distant city, affirms Dr. Rayburn. Ask your doctor for a referral.
Don't be a hero. Airports are huge and when you're pregnant, you're often achy and tired, so don't be too proud to request a wheelchair to help you get around. And always check your bags. "Even if my bag fit in the overhead, I'd check it so I didn't have to ask someone to put it up for me," says Brooklyn writer Caroline Kaye.
Wear your seatbelt. That means in the car or on an airplane (if the seatbelt won't reach across your belly, ask the flight attendant for an extender). And if you're in an automobile accident, be sure to go to the emergency room. "Even if you have no cuts or bruises, if you've been significantly jostled, it's worth getting checked out because you could be at risk for preterm labor," says Dr. Lazarus.
Get your fluids. Dehydration can lead to preterm labor, so drink the recommended eight 8-ounce glasses a day. When flying, don't be shy about asking the flight attendant for plenty of water.
Move frequently. With all that water you'll be drinking, there's no doubt you'll need the bathroom often. If you're traveling by car, stretch your legs at rest stops; if you're flying or going by train, stroll up and down the aisles. Not only will frequent bathroom trips help prevent urinary tract infections (UTIs) and bladder infections (which can lead to preterm labor), but moving around every hour or so helps prevent blood clots in your legs. A blood clot can cause a deadly pulmonary embolism if it reaches your lungs. "Pregnancy hormones make your blood clot more easily, and when you're sitting still, your blood tends to stay in your lower extremities," explains Dr. Wilcox.
Pack healthy snacks. Carrying fruit, nuts, energy bars, or yogurt means you won't be trapped on a runway sans food or at the mercy of fast-food joints – plus, snacks help keep nausea at bay.
Wear comfortable clothes. Stretchy knits and spandex are ideal for travel, and comfortable shoes provide relief from swelling. Celeste Ribbins, a Cleveland communications consultant, kept two pairs in the car when she was pregnant – wide, comfortable slides for quick bathroom stops and shoes with good arch support for walking.
Change your bag. Using a backpack (instead of a tote) helps cut down on back strain, notes Michelle McLaughlin, an Orlando pediatric occupational therapist who traveled often when she was pregnant with each of her three boys.
Pack a travel health kit. Good things to include: acetaminophen, Imodium, Dramamine, Preparation H, Tums, Tylenol PM for insomnia, Cepacol for sore throat, a thermometer, and some packets of Gatorade powder to mix with bottled water in case of dehydration.
Eliminate stress. While many people take vacations to relax, the stress of travel itself might factor into your decision to book that ticket. Some studies have shown a possible link between stress and premature labor, according to Judith Hibbard, M.D., a specialist in maternal-fetal medicine and professor of obstetrics and gynecology at the University of Chicago. So make every effort to minimize the stress associated with travel: Arrive at the airport with plenty of time to spare, or pay extra for a direct flight instead of choosing a cheaper one that requires you to change planes.
The following pregnancy complications are rare. But if you experience any, put your travel plans on hold and see your obstetrician immediately.
1. Bleeding. This could indicate a miscarriage, preterm labor, or blockage of the cervix by the placenta (called placenta previa). Excessive bleeding may require a transfusion and can be life-threatening for you and the baby.
2. Abdominal pain. Cramps that don't go away when you lie down can be a sign of miscarriage or preterm labor. Severe pain with bleeding may indicate that the placenta has separated from the uterus (called placenta abruption).
3. Swelling. Extreme swelling in your arms, hands, legs, feet, or around your eyes could mean that you've developed preeclampsia, a potentially life-threatening condition for you and the baby. Since it typically worsens until the baby is delivered, your obstetrician needs to monitor you closely.
4. Headaches. Pain that doesn't go away with rest and a few Tylenol may signal a sudden rise in blood pressure, another symptom of preeclampsia.
5. Vision changes. Blurred vision, light flashes, or sparkles can indicate swelling around the optic nerve, yet another symptom of preeclampsia.
6. Fetal movement changes. Any significant change in fetal movement could be a sign that the baby is in distress and requires immediate medical attention.