In this article we will discuss the things you need to consider before you set off on a long trip. Much of this can be accomplished with the help of your usual medical or obstetrical provider.

Prenatal Care

Probably the most basic function of prenatal care is to establish, as clearly as possible, what your due date is. Whatever else happens in your pregnancy, what will be done about it depends to a large extent on how far along you are in the pregnancy. Airlines and cruise lines also will likely not allow you to travel without a clear knowledge of your due date.

An ultrasound may warn you of problems that might occur and make your trip inadvisable. A “blighted ovum”, for instance, means that you will likely have a miscarriage. The same can be said of a tubal pregnancy. An ultrasound might also pick up such impending problems as twins, a breech baby, an incompetent cervix or a placenta previa—all conditions that may cause you to reconsider your travel plans.
Of the blood tests you have, probably the most important to know is your blood type.

Most obstetricians nowadays routinely check for infectious diseases such as HIV, syphilis, rubella and hepatitis B. Other blood tests may be advised to check for immunity to measles, chicken pox, whooping cough, toxoplasmosis, cytomegalovirus and hepatitis A.

Before you go on your trip, spend some time with your doctor or midwife to learn how best to handle some of the common pregnancy discomforts such as headache, nausea, heartburn, constipation and swollen feet. And have your provider teach you the signs of a serious situation that requires medical consultation. How much bleeding, for instance, should prompt you to find a doctor? And how many contractions are too many? And how do you tell if your water broke or if it’s just your bladder acting up? All of these questions need to be answered before you set off on your trip.
Finally, get a copy of your prenatal record and carry it with you. You never know when you may need it.

Planning Your Itinerary

Whether your trip is for business or pleasure, you may need to make some adjustments in your itinerary due to your pregnancy.
Remember that one of the common side effects of pregnancy is fatigue. Therefore, you don’t want to pack your itinerary so full that you are too tired to enjoy the trip or accomplish your purposes. Our Number One advice to pregnant travelers is to lighten up!

Business travelers especially tend to schedule their itineraries too tightly. An overnight plane flight leading directly into a series of business meetings and followed by a night of dinner engagements is not good for you or your baby and is not a good way to get a lot accomplished.

Do your best to arrive fresh. If at all possible, upgrade your airline reservation so that you can stretch out and get some rest on the way. And when you arrive, check into your hotel and unwind for at least a few hours.
Consider upgrading your hotel reservations as well. In some of the more remote facilities, having to run down the hall to the bathroom is no fun when you are pregnant and suffering from jet lag. Neither is sweltering through the heat when air conditioning is available.

When it comes to business meetings or sightseeing, set a more leisurely pace. Don’t try to close a million-dollar deal and see all the sights.

If you are traveling for pleasure rather than business, many of the same rules apply. Your fellow travelers will appreciate you being upbeat and energetic for half a day rather than dragging through a full day. And, you will remember the trip with much greater pleasure.

Be extra careful of the types of activities you schedule, as well. Remember that falls and accidents are more likely when you are pregnant. Try to reduce your exposure to dangerous steps, steep hillsides, precarious perches, crowds and public transportation. Also, you are more susceptible to infectious diseases.

The short version—minimize the itinerary and maximize the enjoyment.

Travel Documents

For international travel, you usually need a passport and you often need a visa. But there are other documents you may need as well, especially if you are pregnant, that you may find helpful or even essential.
A copy of your prenatal record will save a lot of grief if you should have any medical problems during your trip. It may even be necessary in order for you to travel. All airlines and cruise lines have regulations regarding pregnancy and travel. Your prenatal record or even a letter from your obstetrician may be needed as proof that you do indeed meet their requirements.

In some situations, you may even need a copy of your marriage certificate or a note from your husband giving you permission to travel. Some countries have had extreme problems with couples carrying out custody battles across international borders. Other nations, due to local customs, are very strict about pregnant women traveling without their spouses. This may offend the sensibilities of some travelers from more liberal countries, but it is always best to check out these issues in advance and, when on foreign soil, to follow the local customs.

Finally, it is becoming increasingly common for customs officials to question the carrying of prescription medications. In some cases, they could even confiscate them. We can provide you with information to minimize this risk.
Travel Insurance One of the first things you may find out when you are pregnant and planning a trip is that your medical insurance does not cover you when you travel overseas.

Even when you are not pregnant, this can be a problem. Medical insurance that is valid at home may simply not be in force if you leave the country. Even if your insurance does remain in effect wherever you go, a hospital or medical provider in another country may not be in a position to bill your insurance company. It is very likely that you will have to pay cash for medical care and then attempt to collect reimbursement from your insurance company when you return home.

But the situation becomes much different when you are pregnant.

For reasons that seem unfathomable to most of us, an insurance company that will cover all your medical problems in your host country, even those related to pregnancy, will suddenly exclude pregnancy-related ailments once you leave home. It is imperative, therefore, that you check on this before you leave for any international travel. We can help you find appropriate coverage.
Having problems with your pregnancy far from home is a major emotional trauma. You don’t need, added to that, a major financial drain. And obstetrical emergencies, when they occur, are often sudden and life threatening.

Finding A Doctor Away From Home

If you will be traveling while you are pregnant, we strongly advise that you arrange—before the trip—for obstetrical care when you arrive at your destination, should it become necessary.
There are several ways of going about this. If you contact us in advance, we can often direct you to one of our many contacts around the world.

Once you have found a good obstetrical provider, arranging for prenatal care and delivery as an expatriate are discussed in a forthcoming article.

When Not to Travel During Pregnancy

Most of the time we find ourselves assuring pregnant women and their doctors that yes, they can safely make this trip while they are pregnant. A few changes and special arrangements may need to be made, but usually a safe trip is possible. When the pregnancy is complicated, however, things are different.

Doctors always want us to divide our advice into “relative contraindications” and “absolute contraindications” to travel. That is “medicalese” for reasons to merely be cautious about traveling versus reasons to absolutely not travel at all while pregnant. It is often difficult to make this distinction. A lot depends on where one is traveling, for what reason, for how long and what activities are planned. There are some situations, for instance, when we would advise a pregnant woman not to take a vacation trip to the remote parts of the Himalayas. But if she was already there, these may be the very reasons that she should travel from there to a better location.
For purposes of discussion we do, however, divide complications into obstetrical ones and medical ones.

Obstetrical complications are those that are caused by the pregnancy itself. These would include things like a threatened miscarriage, a tubal pregnancy, twins, a baby that is breech, premature labor, placenta previa or bleeding during the pregnancy.

Medical complications are those conditions that a pregnant woman may have that, although not caused by the pregnancy, do increase its risk. A pregnant woman with diabetes would fall into this category, for instance, as would someone with high blood pressure. Some situations such as pre-eclampsia can fit in both categories.

With many of the complications of pregnancy, travel may still be possible as long as the patient is very careful about taking care of herself and is going to a place where skilled care is immediately available.
Some medical conditions, however, might worsen during travel and require extra care. A woman with a chronic bowel condition, for instance, is at much greater risk for diarrhea and dehydration if she goes to less developed country. And a pregnant woman with asthma might find herself in dire straits if she went to a city with a lot of air pollution.

Other medical conditions, by their very nature, are a little more apt to suddenly deteriorate. Pre-eclampsia or high blood pressure is an example. A history of blood clots and the need for blood thinners is another. In these cases, we would strongly advise against any casual travel, restricting the patient to trips that are absolutely necessary for the ongoing care of the pregnancy.

And then there are some conditions where we would advise against travel at all, in any sort of vehicle, for any reason. These are conditions where so much could go wrong in transit that it could cost the life of both the mother and baby. Many obstetricians consider a placenta previa to be such a condition, especially if there has been any bleeding.

Other examples might be active labor where delivery in a moving vehicle could be disastrous, or premature rupture of the membranes where the umbilical cord could slip out and get pinched, cutting off blood supply to the baby. Early in pregnancy, we would also be very hesitant about transporting a woman with a suspected tubal pregnancy (it might rupture before she got to help) or a miscarriage with heavy bleeding.

The bottom line is, if your pregnancy is mildly complicated and your trip is low-risk, it may possibly be accomplished with a little extra care. If there is a significant complication, however, it is probably best to get early to a place of skilled care and stay there.

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