Air Travel

The first hurdle that you have to overcome in traveling by air is airline policy.  Each airline has its own rules about pregnancy and travel, and the rules sometimes seem to change by the week.  In the end, it often seems to be up to the gate agent at the time you board.

Obviously, airlines do not want to have obstetrical emergencies aboard their aircraft (and neither do you, for that matter!)  They know that the likelihood of such emergencies increases the closer you get to your due date.  Almost all airlines, therefore, forbid domestic travel beyond thirty-six weeks of pregnancy and international travel beyond thirty-two weeks.

As we said, the rules vary.  Most airlines will have a medical officer or at least an office that you can call to find out what the rules really are.  It is best for you or your doctor to call that office and speak to the appropriate person. That person’s name needs to be written down along with what they said.  You then need documentation in the form of either a letter from your doctor or a copy of your medical records to prove that you do meet the requirements.

Some pregnant travelers are anxious about the effects of cosmic radiation.  Aviation medicine experts believe that this should not be of concern, even with repeated flights.  Thus they do not forbid frequent travel by pregnant flight attendants.

Our greatest concern when advising pregnant air travelers is the risk of blood clots, known in medical terms as “thromboembolic disease” or “deep vein thrombosis” (DVT).  You may have heard of it as “economy class syndrome”—even though it is certainly not confined to economy class passengers.

Because of changes in your circulatory system when you are pregnant, you are at much greater risk of developing blood clots in your legs and pelvis.  This risk is increased by prolonged sitting in one position, and by dehydration, both of which are part and parcel of air travel.  Then, when you get up and move around, the blood clots may tear loose and travel to the lungs.  This event, known as a pulmonary embolus, is often fatal.

Our advice is to carry with you some bottled water and to sit in an aisle seat.  If you don’t already have to go to the bathroom every two hours just because you’re pregnant, then we advise you to drink enough water that you do have to go.  The increased fluid intake plus the increased activity greatly reduces the risk of blood clots.  And don’t worry about irritating the flight crew or the other passengers.  Unless there is a true emergency, they love to make allowances for a pregnant woman.

We do not, by the way, recommend the use of aspirin to prevent these blood clots, although your doctor may have you on it for other complications of pregnancy.  There no good evidence that it helps to prevent these clots, and some studies have shown an increase in other pregnancy-related complications when it is used routinely.

Respiratory infections are also a common side effect of flying while pregnant.  Engorged nasal blood vessels, extra mucus in the lungs, dry air in the airplane and crowded conditions all add up to more germs in your lungs.  Try not to stay around people who are coughing or sneezing and if you develop respiratory problems, treat them promptly (see the chapter on respiratory infections.)  We also routinely recommend flu vaccine for our pregnant travelers.

Once we get past the medical risks, we come to just plain discomforts.

Remember that your intestines move more slowly when you are pregnant.  This means that more gas accumulates.  As the airplane ascends and the air pressure decreases, this gas expands and your abdomen, already swollen from the pregnancy, enlarges even more.

Wearing loose clothing, eating lightly and drinking plenty of fluids will help to diminish this problem.

Swollen feet do not necessarily indicate either blood clots or toxemia.  They are simply a result of dilated blood vessels due to the progesterone in your body.  But be aware that your feet will swell during flight, so wear footwear that is loose enough to accommodate this while being snug enough to prevent your tripping and falling.  Lace-up shoes like sneakers are probably best.

Even though commercial aircraft are pressurized, the air pressure is rarely that of normal sea level.  It usually corresponds to an altitude of 5000 - 8000 feet (1500 – 2500 meters).  This altitude is usually not a problem during pregnancy.  If your pregnancy is already complicated by anemia, however, or by a baby that has been diagnosed as “growth restricted”, the small drop in oxygen level could be critical to your baby.  In those circumstances, it is best to consult your physician before flying.

Finally, pregnancy is not an excuse to leave off your seatbelt.  The belt should be worn low on your pelvis, just under the level of your pregnancy bulge.