By Dagný Zoega.
People love to travel, see new places, taste exotic new dishes, experience a different culture. Travel is usually comfortable and safe in well-maintained modes of transport, and the vast majority of travellers return home safely – happy and richer for the experience. But what about the woman who discovers she is pregnant just after having confirmed the expensive trip to be taken next month, in 3 months or next summer? Is it at all allowable to travel over land and sea carrying one’s heir in one’s tummy? The answer to this question is yes – in the majority of cases. The positive response, however, carries a number of reservations and warnings, and it is always wise to consult a midwife and/or pre-natal care physician before heading off.
Medical services overseas
An essential requirement for a pleasurable and low-risk trip is that the woman is healthy and that the pregnancy is progressing normally and problem-free. It is a good idea to look into the medical services and childbirth assistance available at the destination when deciding where to go. Medical services are generally very good in western Europe and the US, slightly less so in eastern Europe and often difficult to find in poorer developing countries. If travelling with a recognised travel agency, the tour guides will provide information about medical services and will assist travellers in obtaining such services. One must check whether there are any endemic diseases in the destination country and whether vaccines will be necessary. Vaccinating women during pregnancy is not recommended, so if such vaccination is required, it is probably best to postpone the trip or go somewhere else.
Insurance terms must be clear – what coverage does the insurance provide and what papers must be submitted in the country in question in order to receive the necessary medical assistance. Many countries have entered into agreements among themselves so that Icelanders pay the same amount as citizens for medical services, while in other countries, such services are extremely expensive. On arrival back home in Iceland at least, Tryggingastofnun Ríkisins (the Social Insurance Administration) will pay the difference on the submission of valid receipts. Remember to obtain receipts for all medical services accepted overseas, as well as for all medicinal products.
Under normal circumstances, flying does not pose a risk to the foetus. It is well protected in its watery cocoon in the womb. There is no evidence that there is any more risk of labour being initiated in an aircraft than in a car or other vehicle. However, aircraft operators often prefer to ensure that this does not happen and do not accept passengers whose pregnancy has lasted more than 36 weeks. Some airlines require a medical certificate to the effect that the pregnancy is normal and that there is no risk of premature birth or unexpected events during the trip. There is, of course, no way that any physician can promise that nothing will happen, but it is reasonable to obtain such a certificate if one is requested. Find out what arrangements apply with the airline you will be travelling with before purchasing the ticket. One of the greatest risks during longer flights is the length of time the passenger stays seated. Remaining seated for extended periods can lead to blood clots forming in the legs. This risk is even greater during pregnancy than otherwise, as the coagulation system is more active during pregnancy and the veins more elastic and clots more likely to collect. To combat this, it is a good idea to drink plenty of fluids before embarking on the trip as well as throughout the duration of the flight in order to maintain proper fluid balance. To keep the blood flowing, you will need to move your feet – stretch out, wiggle your feet, contract and relax the buttock muscles and regularly stand up and walk about, if possible. Wear clothes that do not constrict your stomach, thighs and groin. A good idea is to wear light support socks during the trip, and you may also want to have a bag or something you can use as a footrest to put your feet up a bit so that your thighs do not rest on the seat edge, allowing a free flow through the veins. In addition, many find it advantageous to take an antithrombotic such as children’s magnyl (125 mg), ½ a tablet the day before a flight and ½ a tablet on the day of the flight; this reduces blood’s coagulation factor so that there is less risk of clotting.
If travelling to a hotter country, you should take care not to overheat and to use a good sun block. Excessive heat can cause foetal damage. In addition, there is a risk of skin pigments clumping up in the sun so that the skin becomes blotchy. Cover up in light-coloured clothing, cool yourself well when you begin to sweat and stay indoors during the hottest part of the day. Take care to drink plenty of fluids to replace fluid lost through evaporation and sweating.
As is true of everyone, pregnant women should only drink boiled water or bottled water and other bottled drinks and decline ice cubes, as they tend to be made from tap water. Beware of shellfish, cheeses and chicken, and only order properly processed food that you are familiar with when eating at restaurants. If purchasing food in supermarkets, make sure that it is plastic-packed and dated. Cook all food thoroughly, and do not eat anything you are not certain about. Breads are usually unpolluted if purchased in supermarkets, although you will have to be careful when selecting sandwich fillings. Soft cheeses and homemade cheeses should be avoided, as should uncooked meats. Fruits are generally fine if peeled or thoroughly washed. Vegetables, on the other hand, should be boiled unless they are in packaging from a recognised grower. Avoid eating anything purchased homemade or gathered by hand from market salesmen. One never knows what might have landed on it.
During pre-natal care, you will be given a variety of advice and instructions that most certainly continue to apply when you travel abroad. Remember to take your vitamins and any medicines you need to use with you. Use common sense and avoid situations that can be dangerous, such as dense crowds and events that you would not participate in at home. For further information, the website doktor.is contains guidelines for travellers. With the exception of these “few” words of warning, travel during pregnancy should not be any more difficult than travelling when not pregnant. If, however, there is any doubt as to whether the pregnancy is progressing normally or if you think that some symptoms might become worse, either due to the travel or the length of time away, you should not embark on a long journey. There is nothing more precious than a new life, and there is no journey worth putting such life, or that of its mother, at risk. Have a good trip.
Dagný Zoega is a nurse and a midwife. This article was first published on the website doctor.is in 2003 and was reviewed and updated on 1 May 2009 by doctor.is. Published with the permission of the author and Doktor.is.