The pregnant girl’s guide to travel

Whether you’re going on holiday via air, land or sea this summer, travelling while pregnant comes with a lot of extra planning. Don’t leave home without knowing these dos and don’ts

FLYING

Before you jet off anywhere, you need to have had an ultrasound to check your due date and confirm you’re having a normal pregnancy. That’s according to Dr Peter Vincent, medical advisor to Netcare Travel Clinics, who says flying while pregnant is either not advised or completely ruled out in highrisk pregnancies.

In normal (low-risk) pregnancies, there’s generally no restriction on domestic or international air travel from 23 to 36 weeks. If you’re carrying multiples, the cut-off is 32 weeks. All airlines have different policies on travel during pregnancy, so you do need to check with the airline direct. “Remember too that the cut-off date usually includes the return date of travel,” says Lucinda Tyler, Club Travel product manager. “So you need to calculate how many weeks pregnant you’ll be when you fly back.” Many airlines require a doctor’s letter confirming you’re fit to fly only in the third trimester, but Lucinda recommends taking a doctor’s letter within the first and second trimesters just in case.

“It’s also a good idea to travel with your prenatal records, doctor or healthcare provider’s contact details and health and/or travel insurance details,” she advises.

SAFETY BY TRIMESTER

Even if the airline allows you to fly, should you?

Dr Vincent advises against nonessential travel during the first trimester. Not only will flying make symptoms such as morning sickness and fatigue worse, he says, “It’s also a time when your body is adapting to hormone changes and the most likely period to suffer a miscarriage.”

The second trimester is a much better time to board that plane. “This is the safest time for a pregnant women to travel, particularly the 18 to 24 week period,” he explains.

He advises only flying during the third trimester if you’re comfortable and have been given the all clear by your doctor, even if you’re well within the 36week cut-off period.

COMFORT AND SAFETY TIPS

Deep vein thrombosis is a risk when flying while pregnant. “It’s said to be five to 10 times higher than in non-pregnant women,” confirms Dr Vincent. He recommends taking preventative measures such as stretching and walking frequently and doing leg exercises, as well as wearing graduated compression stockings. “Keep compression stockings on, and keep leg exercises up for at least 48 hours after a flight longer than eight hours.” Blood thinners to ward off thrombosis are not recommended, unless prescribed by your gynae/obstetrician.

Other tips for staying comfortable when flying with a bump include wearing loose clothing and comfortable shoes, booking an aisle seat close to the toilets, not drinking fizzy drinks before or during the flight (the gas will expand in the pressurised cabin), and avoiding all drinks with caffeine (including teas, coffees and soft drinks).

DRIVING

Like flying, long car drives or bus rides aren’t recommended during the first trimester and should be taken with caution during the third. The second trimester is when you want to be packing the padkos.

Dr Vincent says it’s important to stop and walk around every two hours, as there’s a risk of deep vein thrombosis with long drives. “Also do leg and ankle movements while sitting, and wear graduated compression stockings.” A seatbelt is an absolute must. “A diagonal shoulder strap with a lap belt provides the best protection,” he says. “The shoulder belt should be worn between the breasts with the lap belt low across the upper thighs. When only a lap belt is available, it should be worn low between the abdomen and pelvis.”

CRUISING

Most international cruise lines allow pregnant women on board up until 28 weeks but also require a doctor’s letter saying they’re fit to cruise.

Allan Foggitt, marketing and sales director for MSC Starlight Cruises, which operates cruises locally, says they only allow pregnant women on board if they “do not reach or exceed the 24th week of pregnancy during the trip”. A doctor’s letter is also recommended.

Dr Vincent warns that pregnant women may struggle more with motion sickness on cruises. A good remedy is to add ginger powder to your food or drink. Vitamin B6 tablets should also help.

If the seasickness is severe (constant nausea and vomiting that’s not responding to the other remedies), he says it’s safe for pregnant women to take seasickness medications Cinnarizine or Cyclizine.

TRAVEL INSURANCE

Having a good travel insurance policy is essential, especially if you’re travelling out of South Africa.

“A travel insurance policy will give you peace of mind should you go into early labour and need hospitalisation, and/or repatriation, or experience any other unforeseen complication as a result of your pregnancy,” explains Simmy Micheli, sales and marketing manager for Travel Insurance Consultants. Bear in mind that the standard “free” travel insurance that comes with your credit card is often not sufficient to cover these costs outside of South African borders, and you may need to buy a topup policy or a separate policy altogether. Here’s the most important thing you need to know: even if an airline allows you to fly up to 36 weeks, travel insurers will only insure you for pregnancyrelated medical claims up to 15 weeks before your due date.

“Most travel insurance products in South Africa will only cover any unforeseen complications of a normal pregnancy up to the end of your 25th week of pregnancy,” confirms Simmy. She emphasises ‘normal’ because if your pregnancy is high risk in any way, most travel insurers won’t pay pregnancy related claims.

“If your doctor says you shouldn’t be flying, don’t,” warns Simmy. “Insurers won’t pay claims if you’ve travelled against medical advice.”

TRAVEL MEDICATION & VACCINATIONS

If you’re planning a trip in advance, it’s preferable to have any vaccinations you may need before you’re pregnant. But make sure your timing is right, says Dr Vincent, as it’s recommended you don’t try conceive for 28 days after receiving live vaccines such as yellow fever, MMR or varicella.

If there was no planning (for the trip or the pregnancy!), consult your doctor or a travel clinic about which vaccinations may be needed and which are safe for pregnancy. Travelling to malaria or zika areas while pregnant should be avoided completely, according to the American Centre for Disease Control, as they can cause severe birth defects – or death – in unborn babies.

If travel to a malaria area is absolutely essential, certain malarial medications are allowed but should only be taken under your doctor’s strict supervision. If travel to a zika area is essential, get medical advice on prevention beforehand.

PRODUCT SAFETY

Check that all products are safe for use during pregnancy. Three products you’re likely to use while on holiday include:

AFTER SUN LOTION “Don’t use after sun products containing topical anaesthetic agents, anti-inflammatories or Aloe vera,” cautions Dr Vincent. He suggests using cool compresses, colloidal oatmeal baths and moisturising creams to relieve the symptoms of sunburn, as well as staying well hydrated and in cool, shaded areas until your skin heals.

MOSQUITO REPELLENTS Lotions, gels or sprays with DEET “offer the best protection and are safe to use during pregnancy”, according to Dr Vincent. He recommends DEET over citronellabased repellents, as they offer up to 300 minutes protection, whereas citronella products need to be re-applied every 20 minutes. “Wrist bands offer no protection at all,” he says.

“If you need to apply sunscreen and mosquito repellent, apply the sunscreen first and then the repellent,” he advises. “However, the sunscreen protection will decrease by 30 percent and therefore needs to be applied more often.” SUNSCREEN There are three golden rules for sunscreen:

• Make sure there’s no oxybenzone in the ingredients. This chemical has been linked to low birth weight.

• Always opt for broad-spectrum sunscreen, which protects against both UVA and UVB rays.

• It’s best to go for the old style lotion Download the free Sunscreen app on iPhone and iPad or the free Sunscreen Reminder Pro app for Android. Both these apps work more or less the same: input your location, skin type and the SPF of the sunscreen you’re using, and the app will set a countdown timer to alert you when it’s time for your next slathering of sunblock.

that you need to rub in, not the spray. One of the ingredients in sprays (titanium dioxide) has been classified as a possible carcinogen.

PLAY IT SAFE

You don’t have to spend your entire holiday on a shaded sun lounger (unless you want to). There are plenty of activities that are perfectly safe for pregnant women. “In general, pregnant travellers should be advised against doing vigorous physical activity and activities where there’s a risk of contact with the abdomen or falling,” Dr Vincent says. Almost anything else goes.

SEA Swimming and snorkelling are perfectly safe, but water-skiing, where there’s a risk of falls and/or injecting water up the birth canal, are not. Scuba diving isn’t allowed because there’s a risk of foetal gas embolism.

LAND Walking and gentle jogging is fine. Dr Vincent warns against riding a bicycle, motorcycle or animal, though, as there’s a “risk of falls that could cause trauma to the abdomen”.

MOUNTAINS Skiing and snowboarding is off the itinerary because of the risk of falling. In fact, Dr Vincent says, it’s not a good idea to be on very high slopes at all. Pregnant women should avoid activities at high altitude and avoid sleeping at altitudes nearing 4km.

ON THE NO-FLY LIST

If you have an incompetent cervix, history of premature labour or vaginal bleeding, you’re automatically banned from travel. “Pregnant women with a significant obstetric history, an inadequately controlled or newly diagnosed medical condition, or those planning travel to malaria areas or areas without access to medical care, should be advised against non-essential travel,” Dr Vincent says. He adds that if you have what doctors refer to as “relative contraindications”, you should always seek medical advice before booking a trip, no matter what trimester you’re in. These include abnormal presentation, foetal growth retardation, history of infertility, history of miscarriage, being over 35 years old, multiple pregnancies and placenta previa.