Activities When You Are Pregnant.
As much as we like to think of pregnancy as a normal, healthy state, there are some activities that are just riskier when one is pregnant.
Falls are more common during pregnancy. And their results can be quite serious, both to you and the baby. A fall at home is usually not a major catastrophe. Even if you do hurt yourself, you can usually call on friends for help, or make a quick trip to the emergency room at your hospital. It is not so easy when you are far from home. Especially if you are engaged in activities that tend to occur far from civilization.
We would not totally forbid these activities during pregnancy, but we would advise extra caution, and that you have adequate plans in place to handle an emergency.
Swimming and snorkeling during pregnancy are generally safe, but water-skiing has resulted in falls with injection of water into the birth canal and loss of the baby. Scuba diving is definitely not advised to any depth or at any stage of pregnancy. Even though there may be some scuba activities that are safe in pregnancy, there is at this time no data to support that.
One other consideration regarding risky activities when you are pregnant is that emergency personnel may not be trained or experienced in handling trauma during pregnancy. Not knowing what to do with a pregnant patient often causes delay in appropriate diagnosis and treatment.
So our advice regarding activities far from home is that, as much as possible, you leave the risk-taking for when you are not pregnant. We will be glad to advise you personally regarding your own particular itinerary.
When we speak of travel during pregnancy, we most often think of travel by airplane, or perhaps by train or ship. Car travel, though, is a lot more common during pregnancy.
There is not a lot that needs to be said about this subject, other than to emphasize the importance of seat belts and the prevention of blood clots.
Your seat belt should be worn with the shoulder strap above and the lap belt below your baby bulge. Even then, if you are involved in an auto accident, the pressure of the seat belt can result in premature labor or premature separation of the placenta. Thus, even if involved in a minor car accident it is wise to seek medical attention.
On long car trips, due to prolonged immobility, there is an increased risk of blood clots forming in your legs and pelvis. These can then get loose and travel to your lungs with disastrous results. We advise frequent stops to stretch – which may be made necessary anyway for bathroom stops.
There are a number of issues that arise with air travel for which we can advise preventive strategies and remedies.
The first hurdle that you have to overcome in traveling by air is airline policy. Each airline has its own rules about pregnancy and travel, and the rules sometimes seem to change by the week. In the end, it often seems to be up to the gate agent at the time you board. Your best defense is to carry a copy of your prenatal record and a note from your doctor.
Some pregnant travelers are anxious about the effects of cosmic radiation or of radiation when going through airport scanners. What we advise about this may vary depending on the nature and duration of your travel.
As with travel by car, another concern is the risk of blood clots, known in medical terms as “thromboembolic disease” or “deep vein thrombosis” (DVT). This risk is increased by prolonged sitting in one position, and by dehydration, both of which are part and parcel of air travel. Once again, what we advise for prevention may vary depending on the circumstances.
Respiratory infections are also a common side effect of flying while pregnant. We routinely recommend flu vaccine for our pregnant travelers.
Once we get past the medical risks, we come to just plain discomforts.
As the airplane ascends and the air pressure decreases, gas in your intestines expands and your abdomen, already swollen from the pregnancy, enlarges even more. Swollen feet do not necessarily indicate either blood clots or toxemia but are uncomfortable nonetheless. Dressing in loose clothing and wearing support stockings are two reasonable preventive measures.
Going on a cruise sounds very therapeutic but there are enough health risks involved that most cruise lines will deny you boarding if you are more than twenty-eight weeks along at the time of the cruise.
The closer you get to your due date, the more likely it is that you will suffer from premature labor or other obstetrical complications. Obstetrical emergencies tend to occur without warning and are often life threatening. A cruise ship is usually equipped with an excellent emergency and triage unit and well trained staff. They are not prepared, however, to handle major obstetrical emergencies. And if a ship is a long way from port, it may be as long as twenty four hours before you could expect to get competent help.
Remember that one of the most common symptoms of pregnancy is nausea and vomiting. And one of the most common ailments of cruise travel is seasickness. Put the two together, and you could be in for a very uncomfortable few days. Medicines for nausea are something you may wish to consider before you get on board.
Another common problem of pregnancy is a loss of balance. On a ship the floor is moving, waving and tilting, and you have to go up and down a lot of stairs.
Elevators and public restrooms are places where germs lurk. And when you are pregnant, you are more susceptible to germs including Norovirus and respiratory infections. Thus, it is wise to avoid the public restrooms and wash your hands frequently with soap and use sanitizer.
It is almost impossible to travel to any major city nowadays without running into air pollution.
This can be particularly troublesome when you are pregnant. Your body produces more mucus when you are pregnant. Also, mucus removal from your lungs and nasal passages is slower. That means that you are more apt to have a stuffy nose or a sinus headache. Also, irritants and germs that get into your lungs are removed more slowly. It is a great set-up for pneumonia.
Where pollution is a major problem, try to avoid it. By planning your sightseeing around the worst times and areas, or by spending the worst pollution days on indoor activities, you can see and do a lot without running into difficulties. As a last resort, wearing a scarf around your nose and mouth is often an acceptable alternative.
Altitude and Pregnancy
Travel to some destinations includes the possibility of exposure to high altitudes. For the most part, travel to moderate altitudes (5000-12000 feet; 1500-4000 meters) is considered harmless in pregnancy. There are limits, though, and some conditions in which travel to altitude would be ill advised. Remember that the higher you go the less oxygen there is in the air. Even babies have their limits as to how little oxygen they can survive on, and a baby is dependent on the umbilical cord for its oxygen supply
Also, a baby that is already low on oxygen will not tolerate altitude exposure as readily as an otherwise healthy one. If you are anemic, for instance, your blood is already carrying less than the normal amount of oxygen. Or if you are carrying twins or your baby has been diagnosed as having “intrauterine growth restriction” the oxygen supply is already reduced
One major concern with altitude travel and pregnancy has to do with the fact that many people simply do not tolerate high altitude travel very well. They may develop “acute mountain sickness”. This may be nothing more than simple insomnia and shortness of breath. But it often progresses to include headache, nausea and vomiting. As headache, insomnia, nausea and vomiting are common symptoms in pregnancy anyway, a little bit of altitude sickness can go a long way toward making you feel absolutely terrible.
In serious cases of altitude sickness, there are medicines that are used for treatment. These do not prevent the illness, however, and even when given, their use is combined with a prompt descent to a lower altitude.
One other consideration regarding altitude is that the majority of high altitude activities occur in remote areas, a long way from any available medical care. Obstetrical emergencies tend to be sudden and dramatic. If you are going to go to remote areas when you are pregnant, therefore, you should first make sure that your pregnancy is healthy and you should have arrangements made for transportation to medical care if an emergency occurs.
Heat, Humidity and Hot Tubs
Heat and humidity are a lot harder on you while you are pregnant.
The main way for your body to get rid of excessive heat is to dilate all the blood vessels in your skin. But your blood vessels are already almost as dilated as they can be, with as much blood as possible being shunted to your uterus and kidneys.
When you enter a hot, humid environment, therefore, what little further dilation that can occur is apt to be in your skin and lower body. This directs more blood away from your brain. The result is that your brain tells you to “Lie down!”—that is, you faint.
Fainting is just an inconvenience. Of more concern is that the heat regulation systems do not work as well during pregnancy. Thus, you are more apt to get heat stroke and heat prostration.
At the other end of the spectrum are those who go to ski lodges in the winter and want to relax in the hot tub or sauna.
A study several years ago seemed to show that exposure to high temperatures early in pregnancy increased the risk of having a baby with spina bifida. Subsequent studies have shown that this event is really unlikely if the pregnant woman is taking adequate doses of folic acid (such as in prescription strength prenatal vitamins.)
The Pregnant Traveler Medical Kit
A pregnant traveler should always consider taking her own medical kit.
Adhesive bandages, antibiotic salve and cough drops are pretty self-explanatory. So is a simple pain reliever like acetaminophen. A pregnant woman’s stomach and intestinal tract are always touchy. For that reason, you need to be prepared for any eventuality—heartburn, nausea, diarrhea, constipation and hemorrhoids.
Don’t forget your prenatal vitamins. Prescription strength vitamins are often difficult to find in many countries. Depending on your medical history, we may recommend an antibiotic in case of a severe respiratory or sinus infection, as well as a cream or pill for the all-too-common yeast infection. A simple cold remedy, pre-approved by your doctor, is a good idea as well.
For personal comfort, take along some talcum powder and hand lotion. Since we advise a brisk fluid intake to prevent blood clots, and mealtime is so unpredictable when traveling, we also recommend you take along bottled water and snack foods.
For a complicated pregnancy, there are some other supplies and equipment that we would recommend. We can advise you regarding these items as needed.
There are a number of conditions that, although not dangerous, may require symptom relief during pregnancy.
Nausea and vomiting, for instance, are very common. You may already be suffering from “morning sickness” just because you are pregnant. Add to this the fatigue, irregular meals and motion sickness that often accompanies travel and you may have a real problem. There are several remedies we can recommend for prevention or treatment, some of which require a prescription.
Traveler’s diarrhea is another common issue. We normally do not recommend the use of anti-diarrhea medicines during pregnancy. Rather, we advise prompt treatment if it occurs. Hydration is the mainstay of treatment but in severe cases there are other measures we may recommend, as well as some we strongly advise against.
For headaches, aches and pains, our most common recommendation is acetaminophen. Beyond that, what we will advise depends on the situation. In some cases, a mild narcotic may be preferable to anti-inflammatory medicines like ibuprofen.
Skin preparations such as insect repellents and sunscreens are considered safe to use in pregnancy in normal amounts. Although it has been demonstrated that DEET (the active ingredient in most insect repellents) crosses the placenta, no ill effects from this have been shown.
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