What the Pregnant Flier Can Expect

The question of whether a woman should fly when she is pregnant--especially if her pregnancy is advanced--has always been, well, up in the air. Now doctors have some official recommendations to follow.

Earlier this month, the American College of Obstetricians and Gynecologists, or ACOG, for the first time issued recommendations on air travel during pregnancy, responding to continuing requests for advice from physicians and women travelers.

Air travel is safe for most pregnant women through 36 weeks’ gestation, says Dr. Raul Artal, professor and chairman of the department of OB-GYN and women’s health at St. Louis University School of Medicine and vice chairman of ACOG’s obstetrics practice committee. (Typical gestation is 40 weeks.) U.S. airlines generally allow women up to 36 weeks pregnant on domestic flights but only up to 35 weeks on international flights, according to ACOG. But policies differ by carrier, with some requiring medical clearance after a certain point in pregnancy.

The recommendations apply only to healthy women with low-risk pregnancies, Artal says. Mothers-to-be should not fly if they are at risk of pre-term labor or have placental abnormalities or other health problems.

The recommendations, issued as an official opinion of the ACOG committee charged with studying the issue, are published in the December issue of the organization’s journal, Obstetrics and Gynecology. The new guidelines reflect the standard of care that most doctors have been following, says Dr. Richard Frieder, an obstetrician-gynecologist on staff at Santa Monica-UCLA Medical Center.

For many women, the second trimester is the best time to fly, Frieder says, because they generally have the most energy then. The nausea that can plague the first trimester and the fatigue common in the last trimester can make travel difficult. And increased weight in the last trimester can make getting in and out of airplane seats a chore.

At any stage of pregnancy, women should take precautions to ease discomfort aloft, Artal says. One way is to avoid gas-producing food and carbonated drinks before takeoff, because high altitude may worsen discomfort from bloating and gas. (They can be more of a problem during pregnancy, Artal notes, because the stomach, like other internal organs, is compressed as the uterus expands.)

Frieder tells his pregnant patients to consider requesting an aisle seat so it will be easier to get up, walk around and get to the bathroom. But walking around the plane at other times may be hazardous if a woman is having balance problems or if the aircraft encounters turbulence, Artal says. He recommends staying seated and keeping the seat belt on, wearing it low on the hipbones between abdomen and pelvis. Instead of walking, he suggests that pregnant women rotate their ankles frequently to lessen swelling and stimulate blood circulation.

Because airline policies differ, women who fly during pregnancy should also check with the carrier. Some require clearance from the woman’s physician, validating fitness to fly if the trip occurs late in pregnancy.

For women up to 39 weeks in a normal, uncomplicated pregnancy, American Airlines, for instance, does not require a medical certificate for flights within the U.S. or to Canada, which are usually less than five hours. But those who travel within seven days before (or after) delivery must have a medical certificate or a letter from their doctor stating their fitness to fly.

American Airlines says a woman should not fly internationally within 30 days of her due date unless an obstetrician has examined her within 48 hours of departure and certified her fit to fly.

Airline officials acknowledge that it is sometimes difficult to determine how far along a pregnant woman is just by looking at her, and they generally take her word for it. If a woman is unusually big for her stage of pregnancy, she might consider carrying a doctor’s note stating her fitness to fly and her predicted due date, suggests John Lampl, a spokesman for British Airways. He adds that the airline will accept pregnant travelers through the eighth month with no special information from their doctors.

“If a woman is traveling in the ninth month, we require a letter from the doctor saying it is OK,” he says. Check-in agents may ask women who are in their ninth month--or look as if they could be--about the status of their pregnancy, Lampl says.

JetBlue urges women to contact their doctors if they plan to fly during the third trimester, but the airline does not require a doctor’s letter, a spokeswoman says.

Most airlines that require medical notes enforce the policy, spokespersons say. On American Trans Air, or ATA (a domestic carrier based in Chicago and Indianapolis), for instance, a woman within seven days of her due date who does not have written approval from her physician can be refused boarding, says Angela Thomas, an airline spokeswoman.

What if a woman goes into labor on the plane? There are no federal guidelines requiring a carrier to make an emergency landing, says Jerry Snyder, a spokesman for the Federal Aviation Administration.

But the medical kits that must be aboard commercial airlines include such materials as scissors and gauze (which can be used to tie the umbilical cord), which can help at childbirth, he adds. The FAA doesn’t track the number of births aloft, he says.

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Healthy Traveler appears twice a month.