Whether her travel plans were for business or pleasure, Marylou Marsh didn't let pregnancy slow her down. When she was seven months along with her son Derek, now 6, she flew from her New Jersey home to North Carolina for a business meeting. When she was six months pregnant with her daughter Ariel, now 4, she and her husband Daniel Sanders took Derek on a Florida holiday.
Traveling during the second trimester was easiest for Marsh, who is vice president of Ecosport, a sportswear manufacturer. She echoes the advice of most medical experts, who consider the second trimester the most trouble-free travel time. By then, most bodies have adjusted to the pregnancy. Morning sickness is often over and weight gain is not yet so great that movement is difficult.
Physicians are generally lenient about travel during pregnancy--as long as the mother-to-be is in good health, the delivery date is not imminent and the destination or activity is not hazardous. Scuba diving, for example, should be avoided during all of pregnancy because of the risk of pulmonary embolism (blockage of arteries to the lungs) to both mother and fetus, according to Dr. Raul Artal, chairman of obstetrics and gynecology at the State University of New York, Syracuse.
Most important, experts agree, is for a woman to discuss her travel plans well in advance with her doctor. Overseas travel--particularly to areas where medical care may not be as advanced as that found in the United States--can require extra planning. And whatever the destination, packing a few key pieces of medical information can make treatment on the road, if necessary, speedier and safer.
In general, "travel doesn't pose that much of a medical risk" during pregnancy, said Dr. Arthur Wisot, a South Bay obstetrician-gynecologist who encourages his patients to pack lightly and avoid carrying heavy baggage. "We usually recommend to our patients that they avoid substantial travel during the last month," he added.
No particular mode of transportation is recommended over another during pregnancy, but the choice might hinge on the policies of specific carriers. It's advisable to check with tour groups and carriers before making plans, since policies vary widely. Officials with Maupintour and Club Med, for example, said there is no company policy against accepting reservations from women, even in late stages of pregnancy, but they strongly advise women to seek their doctor's opinion before making travel plans.
Some airlines require a woman flying within 30 days of her due date to provide a doctor's statement saying air travel will not pose health risks for her. Other airlines say they require a doctor's approval as early as in the seventh month. Some others ask for the note only if the woman makes her pregnancy known. (In reality, say some obstetricians, most airlines practice an "If you don't ask, we won't ask," approach.)
At Amtrak, "no note is required," said Bruce Heard, director of public affairs, "but we would recommend getting a doctor's OK prior to travel."
Cruise lines generally discourage women from booking during the last three months of pregnancy.
If a pregnant woman is traveling by car, seat-belt use is advised. For comfort, buckle the belt below the abdominal bulge, advise physicians at the American College of Obstetricians and Gynecologists, and place the shoulder belt snugly between the breasts. Car trips should be limited to five hours of driving time a day, according to the ACOG.
Vaccinations must be discussed in detail with a doctor before leaving. "With pregnancy, live vaccines are the main problem," said Rosamond R. Dewart, chief of the Travelers' Health Section for the Centers for Disease Control and Prevention. Vaccinations for measles, for example, are made from live organisms. Cholera, typhoid and rabies vaccines are made from inactivated viruses or bacteria.
With every vaccine, said Dewart, the risk of the disease must be weighed against the risk of the vaccine's side effects and any danger to the unborn child. According to the CDC's "Health Information for International Travel," live vaccines are not generally given to pregnant women or to those likely to become pregnant within the next three months of vaccine use. The risk of inactivated vaccines is considered much lower, but women should still check with their physicians before using them.
Updated information on vaccinations and other travel-related information is available from the CDC's International Travelers' Hotline, (404) 332-4559, either via recorded information or facsimile machine.
During pregnancy, Wisot tells his patients, "you have to be more careful than the average traveler." That means avoiding food and drink that might be contaminated, moving around during a long airplane flight or train ride to minimize discomfort and, he said, "no para-sailing."
Pregnant travelers should also take along a medical file, Wisot advised. It should include basic information about the pregnancy and due date, a report of the ultrasound, if one has been administered, blood type and a list of any medications or special conditions, he said.
If medical care is needed during the trip, Wisot said, the medical record will make it easier on doctor and patient. Before taking any medicine prescribed by a doctor at the destination, be sure to ask if it is safe during pregnancy, experts advise, especially if your condition is not yet evident.
Pregnant women should also ask their doctor for a list of doctors at the destination, if possible. For overseas trips, it's a good idea to take along a list of English-speaking doctors. (The International Association for Medical Assistance To Travellers publishes a free list of English-speaking doctors and hospitals. Write IAMAT at 417 Center St., Lewiston, N.Y. 14092.)
For overseas trips, it's also a good idea to find out if your health insurance plan is in force and to purchase supplemental traveler's insurance, if necessary.
Danielle Fearnley of Los Angeles flew about 10 round trips while pregnant with her daughter Martha, now seven months. Her advice: "Take along an inflatable headrest. Take off your shoes. Drink lots of water. And sit as close to an exit as possible (to minimize walking)."