When Not to Travel During Pregnancy

Most of the time we find ourselves assuring pregnant women and their doctors that yes, they can safely make this trip while they are pregnant.  A few changes and special arrangements may need to be made, but usually a safe trip is possible.  When the pregnancy is complicated, however, things are different.

Doctors always want us to divide our advice into “relative contraindications” and “absolute contraindications” to travel.  That’s “medicalese” for reasons to merely be cautious about traveling versus reasons to absolutely not travel at all while pregnant.  It is difficult to make this distinction.  A lot depends on where one is traveling to, for what reason, for how long and what activities are planned.  There are some situations, for instance, when we would advise a pregnant woman not to take a vacation trip to the remote parts of the Himalayas.  But if she was already there, these may be the very reasons that she should travel from there to a better location.

For purposes of discussion we do, however, divide complications into obstetrical ones and medical ones.

Obstetrical complications are those that are caused by the pregnancy itself.  These would include things like a threatened miscarriage, a tubal pregnancy, twins, a baby that’s breech, premature labor, placenta previa or bleeding during the pregnancy.

Medical complications are those conditions that a pregnant woman may have that, although not caused by the pregnancy, do increase its risk.  A pregnant woman with diabetes would fall into this category, for instance, as would someone with high blood pressure.  Some situations such as toxemia really fit in both categories.

With many of the complications of pregnancy, travel may still be possible as long as the patient is very careful about taking care of herself and is going to a place where skilled care is immediately available.  A woman who is a well-established diabetic, for instance, and used to monitoring her blood glucose levels and adjusting her insulin dosage, might safely make a trip from one urbanized area to another.  This would especially be true if she had obstetricians at each end of the trip who were willing to co-manage her condition.

Some other conditions that fall into this category might include a pregnant woman who has a well-controlled seizure disorder, asthma, irritable bowel syndrome or a thyroid disorder.  The rules here would be that the condition is under good control, the patient is able and willing to follow strict guidelines (including self-testing when necessary) and she has made arrangements for skilled care at the destination, should it become necessary.

Even a woman who has such obstetrical complications as twins, incompetent cervix or a baby that is breech might consider travel when she is showing no signs of labor.  In fact, this might be a good time to travel to an institution with a higher level of care than where she is presently staying.

Some medical conditions, however, might worsen during travel and require extra care.  A woman with a chronic bowel condition, for instance, is at much greater risk for diarrhea and dehydration if she goes to an undeveloped country.  And a pregnant woman with asthma might find herself in dire straits if she went to a city with a lot of air pollution.

Other medical conditions, by their very nature, are a little more apt to suddenly deteriorate.  Toxemia or high blood pressure is an example.  A history of blood clots and the need for blood thinners is another.  In these cases we would strongly advise against any casual travel, restricting the patient to trips that are absolutely necessary for the ongoing care of the pregnancy.

And then there are some conditions where we would advise against travel at all, in any sort of vehicle, for any reason.  These are conditions where so much could go wrong in transit that it could cost the life of both the mother and baby.  Many obstetricians consider a placenta previa to be such a condition, especially if there has been any bleeding.  In this case, bleeding can be so sudden and so profuse that a woman could bleed to death in minutes.  Even in a well-equipped air ambulance it would be impossible to handle this situation. 

Other examples might be active labor where delivery in a moving vehicle could be disastrous, or premature rupture of the membranes where the umbilical cord could slip out and get pinched, cutting off blood supply to the baby.  Early in pregnancy, we would also be very hesitant about transporting a woman with a suspected tubal pregnancy (it might rupture before she got to help) or a miscarriage with heavy bleeding.  In cases like this we feel it is much better, when possible, to bring skilled help to the patient than to try to transfer her to a better location.

The bottom line is, if your pregnancy is mildly complicated and your trip a low-risk one, it may possibly be accomplished with a little extra care.  If there is a significant complication, however, it is probably best to get early to a place of skilled care and stay there.