Obstetrician, Gynecologist, and Travel Agent

December 14, 2007

One of my pregnant patients recently asked me about traveling during her pregnancy.

You would think that this is a simple enough question. But before a seemingly straightforward answer rolls out of an obstetrician's mouth, it's interesting to consider what goes on in her doctor's thinking regarding this. First of all, you have to know that pregnancy, although commonly a natural phenomenon with an expected natural result, can sometimes throw a few surprises. In fact, besides a heart attack, pregnancy is one of the few medical conditions in which you can be normal one moment and suffering life-threatening complications the next. The list of all of the things that can go suddenly wrong fill books that we OBs all have to read and know. And I can tell you that even after four years of resident training at Charity Hospital and almost twenty years in private practice, I still see complications that are new to me. There are complications that occur once in 40,000 pregnancies, for instance, that happen in an obstetrician's practice once in a professional lifetime, if at all. Do you really want any of these things to happen at 35,000 feet over the Pacific?

Where's The Nearest Hospital in Case of Labor or Pregnancy Complication?

The crucial question is how far is the nearest hospital that is equipped to handle a quickly deteriorating complication. Is it just a turn off the nearest exit on the I-10, or is it a delayed helicopter ride from a cruise ship to the nearest third world island facility?

During the first trimester (the first twelve weeks of pregnancy) the two biggest risks are spontaneous miscarriage and ectopic pregnancy. A miscarriage is a natural event, and although it can become dangerous with serious infection or exaggerated bleeding, it usually is a self-limited complication. In fact, today we often don't do D&Cs (scraping the womb to finish the miscarriage), allowing this unfortunate and sad event to resolve on its own. An ectopic pregnancy, on the other hand, is a surgical emergency. This is a pregnancy in a tube, ovary, or abdomen instead of the womb. The end stage may involve rupture of one of these structures, causing internal hemorrhage. So an overnight canoe trip, for instance, would pose a particular risk if you had to paddle several miles of river to your car before you could be driven to the hospital while bleeding internally.

The second trimester (weeks thirteen through twenty-four) are considered the most stable. This is why any necessary surgeries are delayed, if possible, until this time. The most fearsome risk would be an incompetent cervix, which is a weak mouth of the womb. A woman with this condition is at risk of painless dilatation and therefore premature delivery. Luckily, this is usually a diagnosis made during the first trimester based on a history of prior pregnancy problems, giving an obstetrician plenty of warning. Placenta previa (afterbirth lying in front of the baby) can cause deadly (to both mother and baby) hemorrhage. But ultrasound can rule this out before any planned trip, eliminating this travel risk.

The third trimester ushers in a new element to consider--survivability. Historically, the delivery of a baby in the first trimester (miscarriage) or second trimester is incompatible with life. But a delivery in the third trimester (after twenty-four weeks) in today's world of technological miracles can be a salvageable baby. The more advanced the pregnancy beyond twenty-five weeks, the better the chances. So travel during this time needs to consider not just the availability of a hospital, but how equipped it is to handle very premature babies.

Precaution Is Key To Prevent Pregnancy Complication

A little precaution can reassure the safety of a trip. Long boat rides, overnight camping trips, and flights over oceans, though, make me extremely nervous as an obstetrician. And of course the last month in any normal pregnancy is best spent at home in case plain ol' normal labor happens, because it does. Even with a completely normal pregnancy, landing in an excellent hospital as a surprise to an obstetrician who's never seen you before is a major disruption in the continuity of care. So I think the biggest dangers of travel during pregnancy are rustic outings (overnight camping and canoeing, etc.), flights over oceans, and travel to countries that don't offer what you would want should you have a complication. Interstate travel by car is safer, except that it's ill-advised during the last month of pregnancy. And it goes without saying that any travel when there are established risks is not wise. Ask your doctor if you can go, but give him or her a moment to size up the situation peculiar to you.

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