Traveling While Pregnant

Everyone loves a vacation, and sometimes getting away from it all is just what the doctor ordered. But if going on vacation means traveling any great distance, you might want to think twice.

"If you're 28 weeks pregnant, this isn't the time to fly to Hawaii," says Ralph Dauterive, MD, chief of obstetrics and gynecology at the Ochsner Clinic Foundation in Baton Rouge, La.

"When my patients ask me whether it's all right to travel, I always ask them if they really want to hear my answer," says Dauterive. "Why are you taking a long trip when you're pregnant? How many times in your life are you going to be pregnant? What's your priority?"

That said, however, Dauterive adds, he's not nixing travel for all pregnant women, or for the entire term of their pregnancy. For women who are experiencing an uneventful pregnancy and are at low risk for complications, Dauterive generally considers it safe to travel until 28-30 weeks of pregnancy.

After that, he explains, the risk of preterm labor and complications such as ruptured membranes and bleeding, go up. If that should happen, it's best to be within 90-100 miles of your doctor and your hospital so you can get to them when you need them.

"Late in the third trimester is when things are going to happen," says Dauterive. "Traveling at such a time is not the best idea."

If you're having a complicated pregnancy or have conditions such as high blood pressure or diabetes, traveling at all is a no-no, Dauterive says.

It's not just being able to guarantee that you get the best care that makes staying close to home at the end of your pregnancy a wise choice, says Dauterive. It's making sure your baby has what he or she needs as well. "If there's a problem with the baby, and you're not at a hospital that can handle the problem, you're really rolling the dice," he cautions.

Mark Kufel, MD, an ob-gyn at Michael Reese Hospital in Chicago, takes the approach that pregnancy is a natural, physiologic process, and not a disease. His approach to prenatal care, he says, is based on this assumption, and that includes his views on traveling while pregnant.

"Travel is no more dangerous for the pregnant woman than for her non-pregnant counterparts," he says, adding, however, that some adjustments should be made.

Kufel usually recommends a maximum of six hours a day driving over long distances, with frequent breaks along the way. "This is usually the case anyway," he says, "as the bladder seems to require a little extra attention as well!" Stopping every two hours or so and walking around for 10 minutes will usually suffice. This increases blood flow from the lower extremities, he explains, and lessens the risk of blood clots, which is increased in pregnancy.

Continue to use your seatbelt when in a car, says Kufel, but as your pregnancy progresses, wear it under the abdomen. Extra pillows are also helpful in keeping you comfortable.

When it comes to flying, I. Dale Carroll, MD (aka "The Travel Doctor"), says what is and is not advisable varies greatly from one pregnancy to the next, but some general rules do apply.

For starters, she says, air travel can increase your risk of dehydration. To prevent this, drink plenty of fluids throughout the flight (but not caffeine or alcohol as these aggravate dehydration). Extra fluids may also help prevent constipation, another aggravating difficulty in pregnancy.

Prolonged sitting, especially in a cramped position, can also cause blood clots in the legs and pelvis. To minimize the risk, sit in an aisle seat so that there's room to stretch and more freedom to move around. If possible, upgrade to business class for the same reason. The extra legroom can also help prevent the swollen feet that so often complicate pregnancy.

"Don't sit for more than 90 minutes without getting up and walking around," advises Carroll.

Pregnancy, with its increased demands on the heart, can make high altitudes difficult as well, says Carroll. Because commercial airliners are pressurized, airline flights are not a problem from this standpoint unless you have heart or lung disease. But traveling to a high altitude destination could be an added stress and should not be undertaken without your doctor's go-ahead.

Many of the complications of pregnancy should also cause you to think twice before undertaking any long trips, Carroll says. If you've had bleeding during any trimester, you probably want to make sure you're in a situation where prompt medical attention -- and a safe blood supply -- are available. If you're at risk for premature labor (if you're carrying twins, for example, or have already had a pregnancy with premature labor), you may also want to stay home near your doctor. And if you have diabetes, when tight blood sugar control is so important, you may not want to change time zones and recalculate your insulin dosages.

Carroll also says it's wise to check airline rules and regulations when traveling while pregnant. Many airlines will not allow pregnant travelers to fly beyond a certain point in their pregnancy or without a note from their doctor.

And as long as you're checking ahead of time, adds Dauterive, look into your healthcare coverage. In certain managed care contracts, if you travel and deliver past 28-32 weeks outside your geographical coverage location, you may find yourself responsible for additional costs.

Planning ahead is key, agrees Kufel. If you're leaving the general vicinity of your home, he recommends taking along a copy of your medical/prenatal records. This way, if you do need medical care, you have the basics with you. This includes your medical history, your prenatal lab work, ultrasound reports, etc., all of which can be helpful in case of an emergency. Kufel also recommends asking your own doctor for a recommendation for a substitute physician in the area where you'll be traveling -- just in case.

Finally, when we're all a bit stressed out -- pregnant or not -- Kufel cautions that stress can manifest itself in a number of ways, including preterm labor or preterm contractions. "Education is key," he says. "A prepared patient is much more able to cope with stresses ... if she knows what to expect, and how to deal with the possible complications."