Traveling While Pregnant or Breastfeeding
Although traveling during pregnancy is normal and occurs rather frequently, it is important for pregnant women to consider potential problems that could arise when considering international travel. Pregnant women should also weigh the availability of quality medical care in the countries they are visiting, before traveling abroad. Preconceptual immunizations are preferred over vaccination during pregnancy.
According to the American College of Obstetricians and Gynecologists, the safest time for a woman to travel is in the second trimester of her pregnancy - from 14 to 28 weeks. This is the time when women feel the best and are at the least risk for spontaneous abortion or premature labor. During the third trimester (25 to 40 weeks), many physicians/midwives advise staying within a 300 mile radius of home because of problems such as hypertension, phlebitis, and/or false or preterm labor. Generally, women are not allowed to travel by air after 36 weeks for domestic travel, and after 32 to 35 weeks for international travel. The decision on whether to travel and how far to travel at any time during pregnancy should be a joint decision between the woman and her physician/midwife.
According to the Centers for Disease Control and Prevention (CDC), pregnant women with the following conditions may be advised against traveling to international destinations that require pre-travel immunizations. As the list below may be incomplete, it is important to discuss your individual medical history with your physician/midwife before planning travel.
- History of miscarriage
- Incompetent cervix
- History of ectopic pregnancy
- History of premature labor or premature rupture of membranes
- History of or current placental abnormalities
- Threatened misscarriage or vaginal bleeding during current pregnancy
- Multiple gestation (more than one fetus) in present pregnancy
- History of toxemia, hypertension, or diabetes with any pregnancy
- History of infertility or difficulty becoming pregnant
- Pregnancy for the first time over the age of 35 years
- Valvular heart disease or congestive heart failure
- History of thromboembolic disease
- Severe anemia
- Chronic organ system dysfunction requiring frequent medical interventions
Pregnant women may also be advised against traveling to the following destinations which present additional hazards. As the list below may be incomplete, it is important to discuss your travel plans with your physician/midwife before planning a trip.
- Areas with high altitudes
- Areas endemic for or with ongoing outbreaks of life-threatening food- or insect-borne infections
- Areas where malaria is common
- Areas where live-virus vaccines are required or recommended
Anticipate any complications or emergencies that could arise before you travel. Check to make sure your health insurance is valid while you are abroad, and check to see whether the policy will cover a newborn, should you deliver while away. You may want to consider obtaining a supplemental travel insurance policy and/or medical evacuation insurance policy.
- Research medical facilities in your destination. Women in the last trimester of pregnancy should look for facilities that can manage complications of pregnancy, toxemia, and cesarean sections.
- If you will need prenatal care while you are abroad, arrange for this before you leave. Consult with your physician/midwife to determine the best way to handle this.
- Know your blood type and check to make sure that blood is screened for HIV and hepatitis B in the areas you will be visiting.
- Check on the availability of safe food and beverages, including bottled water and pasteurized milk, in your destinations.
- If traveling by air, request an aisle seat at the bulkhead, which provides the most space and comfort. If morning sickness is a problem, try to arrange travel during a time of day when you generally feel well. Seats over the wing in the midplane region will provide the smoothest ride.
- Try to walk every half-hour during a smooth flight, and flex and extend your ankles frequently to prevent thrombophlebitis.
- Fasten your seat belt at the pelvis level, below your hips.
- Drink plenty of fluids to counteract the dehydrating effect of the low humidity in aircraft cabins.
- Try to rest as much as possible while away. Exercise and activity during pregnancy are important, but try not to overdo it.
Infants are particularly susceptible to pain with Eustachian tube collapse during pressure changes on take-off and landing. Breastfeeding your infant during these times can often greatly relieve this discomfort as the suckling reflex helps to activate the muscle that opens the Eustachian tube, thus, releasing pressure on the middle ear.
Breastfeeding gives babies the most nutritional start in life, as well as provides them with important protection against certain infections. However, traveling internationally while nursing can present challenges. Outlined below is information breastfeeding moms should consider when traveling.
For women who are breastfeeding only, there is no concern about sterilizing bottles or the availability of clean water. Nursing women may be immunized for protection against disease, depending on their itinerary. However, there may be certain diseases, such as yellow fever, measles, and meningococcal meningitis, which may be a threat to infants who cannot be immunized at birth, as an infant would not gain protection against these infections through breastfeeding. It is important to discuss this with both your physician/midwife and your infant's care provider before you travel.
For women who are supplementing breastfeeding with formula, powdered formula prepared with boiled water is the best solution. You may also want to carry a supply of prepared infant formula in cans or ready-to-feed bottles for emergencies.
Breastfeeding helps lower the incidence of traveler's diarrhea in infants. However, if you should develop traveler's diarrhea, increase your fluid intake, and continue to nurse your infant.
It is important for nursing mothers to watch their eating and sleeping patterns, as well as their stress levels which will affect their milk output. Be sure to increase your fluid intake, and avoid alcohol and caffeine, as well as exposure to smoke.
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