An Introduction— Read this first

When a pregnant woman travels overseas, she or her doctor often starts by asking about vaccines and medicines.  These topics are the most apt to raise concern but are rarely the issues that really affect the safety of a particular trip.

In this chapter, our aim is to give you an overview of all the problems that may be encountered in international travel.  This will raise your awareness of where the real problems lie and alert you to issues you may not have considered.  We encourage you to read through this chapter before proceeding on to other topics.  The links will then lead you to a more detailed discussion of each particular problem area.  Also, most of our discussion here is limited to how these problems relate to pregnancy.  More a more thorough discussion of many of these diseases and problems we refer you to our parent web site at The Travel Doctor (www.travdoc.com).

When you first tell your obstetrical provider that you want to travel, he or she may suffer from “travel panic”, not knowing what medical care is available overseas or how to adjust for certain conditions.  A travel medicine specialist, on the other hand, may suffer from “pregnancy panic.”  He or she knows all about travel medicine but doesn’t know how to apply this knowledge to a pregnant patient.  When your medical provider needs guidance or reassurance, we offer a consultation service and can guide them to the medical data that will help them make the right decision.

We need to start by saying that pregnancy is not an illness or a disability.  Rarely does travel need to be flatly forbidden during pregnancy.  Almost always, travel during pregnancy can be made safe and possible.  But pregnancy, even a normal pregnancy, is clearly an altered state of health.  And the alterations that come with pregnancy almost always make a difference in how one must go about planning and preparing for travel.  If you are pregnant and planning a trip, be prepared to make some special allowances because of the changes in your body and for the sake of your unborn child.

There are a number of changes that occur in your body with pregnancy and these may affect your travel plans.

For instance, your hormone levels rise drastically when you are pregnant.  Blood volume increases by fifty per cent, you breathe more deeply, your intestinal tract relaxes, your kidneys work overtime and your immune system slows down.  As a result, you are much more susceptible to many of the illnesses and ailments that afflict travelers.  Diarrhea, vomiting, respiratory infections, headaches, blood clots, virus infections and malaria all are much more common and much more dangerous when you are pregnant.  Even common pregnancy discomforts such as a stuffy nose, morning sickness, constipation and swollen feet become much more of a problem when you are far from home.

Because of the problems you may encounter during travel, your prenatal visits prior to the trip may need to be more detailed.  An early ultrasound will help to establish a reliable due date (essential knowledge when other problems arise) as well as to rule out such complications as twins, placental abnormalities, cervical incompetence and a tubal pregnancy.  As Rh negative blood is impossible to find in some parts of the world, it is important to know your blood type.  It is important, as well, to know if you are immune to a number of diseases that now are rare in industrialized countries but still may be encountered when going to other parts of the world.

Documents often become more important when you are pregnant.  Depending on where you are going, the rules of the carrier, and the length of your stay you may need more than just a passport and visa.  A copy of your prenatal record, a letter from your obstetrician, a copy of your marriage certificate and even a letter of permission from your spouse may be required as well.

You also need to carefully examine your medical insurance policy.  Most insurance companies will not cover pregnancy-related problems in another country, and many travel insurance policies specifically exclude pregnancy. 

Pre-travel planning should include exactly what you will do if you encounter a problem while on your trip.  You also need to discuss with your obstetrician how to handle the minor discomforts of pregnancy, and how to tell the difference between a small inconvenience and a major complication.

There are a number of infectious diseases that pose a much greater risk in pregnancy.  These include traveler’s diarrhea, respiratory infections, hepatitis, urinary infections, parasitic infestations and, above all, malaria.  Special measures in the prevention and treatment of these diseases are discussed in separate chapters.

As mentioned above, vaccines and medicines raise more questions than any other topic.  We discuss these matters thoroughly in other chapters, but two basic principles apply.  The first principle is that of avoidance.  If you can arrange your trip so as to avoid exposure to the diseases that require these vaccines or medicines, then it is best to do so.  If exposure is unavoidable, however, you may need to apply the principle of comparative risk.  What that means is that the disease you are trying to prevent probably presents a far greater risk to you and your baby than does the vaccine or medicine needed to prevent it.

A separate chapter is devoted to the common discomforts of pregnancy, what can be done to minimize them and what you should include in a medical kit to carry with you.

Other issues that you may need to consider before you travel include such things as air pollution, climate and altitude all of which may present more of a hazard when you are pregnant.  Various modes of travel (even going on a cruise) each present their own risks, which may vary depending on the destination.  The same goes for some sorts of sports and activities, especially if you will be far from medical care.  Accidents remain a major danger in both pregnancy and travel.  And many emergency care providers simply do not know what to do when confronted by a traumatized, pregnant woman.

If you are fortunate enough to be going through a perfectly normal pregnancy then there is little reason for you not to travel.  But a complicated pregnancy may be a different matter.  Some complications may be as safely handled in a foreign destination as at home.  As long as you know what to look for and how to handle it, competent care may be available in your destination country.  But other complications constitute so great a risk during travel that death of both the mother and baby could result.  Even traveling to a place of competent care could present an unacceptable risk in some of these situations.

If you do suffer an accident or complication far from home, you may have difficulty in obtaining transportation to competent care.  Travel by commercial airline may be an option, but sometimes is not.  There are companies that handle medical transport of pregnant women, but they vary greatly in their training and expertise.  This is another issue that should be investigated before you leave home and the proper arrangements made.

Finally, there is the pregnant expatriate—the woman who is not only traveling while she is pregnant but will actually be living overseas during the pregnancy.  Finding good prenatal care and delivery facilities can be difficult, even if you do know what to look for.  And then there are citizenship issues, care of a newborn infant in a foreign situation, how soon after delivery it is safe to travel and even, for many, the issue of newborn circumcision.

As you can see, there is a lot more at stake than just what shots you need to go to a certain country.  Traveling when you are pregnant presents some very real problems.  So much so that you may decide just not to take the trip.  But if you must travel, or if you really do not want to cancel the trip, it can usually be accomplished safely and comfortably—as long as you are willing to make some extra preparations and perhaps accept some modifications in your travel plans.

We trust the other chapters on this web site will reassure you and give you more information on how to prevent and handle the challenges of traveling while pregnant.