So you are pregnant and you find yourself planning a short haul (under four hours), medium or long haul (over four hours) flight and don’t quite know the ‘rules’.

I think the most important question you will have is: Will flying harm me or my baby?

If your pregnancy is straightforward, flying is not harmful for you or your baby:

• If you have a straightforward pregnancy and are healthy, there is no evidence that the changes in air pressure and/or the decrease in humidity have a harmful effect on you or your baby.
• There is no evidence that flying will cause miscarriage, early labour or your waters to break.
Anyone who flies is exposed to a slight increase in radiation. Occasional flights are not considered to present a risk to you or your baby.

If you are a member of a flight crew or you fly frequently as part of your work, you should seek additional
advice from your occupational health department concerning your own situation.

When is the safest time to fly during pregnancy?

When you are pregnant, the safest time to fly is:

• Before 37 weeks, if you are carrying one baby. From 37 weeks of pregnancy you could go into labour at any time, which is why many women choose not to fly after this time.
• Before 32 weeks, if you are carrying an uncomplicated twin pregnancy.
Most airlines do not allow women to fly after 37 weeks. It is important that you check with your airline before flying. It may also be more difficult to get travel insurance after 37 weeks.

You may also ask the question: Am I at increased risk of problems if I travel by air?
Some pregnant women may experience discomfort during flying.

You may have:
• swelling of your legs due to fluid retention (oedema)
• nasal congestion/problems with your ears – during pregnancy you are more likely to have a blocked nose and, combined with this, the changes in air pressure in the plane can also cause you to experience problems in your ears
• pregnancy sickness – if you experience motion sickness during the flight, it can make your sickness worse.

Deep vein thrombosis (DVT)

A DVT is a blood clot that forms in your leg or pelvis. If it travels to your lungs (pulmonary embolism) it can be life threatening. When you are pregnant and for up to six weeks after the birth of your baby, you have a higher risk of developing a DVT compared with women who are not pregnant.
There is an increased risk of developing a DVT while flying, due to sitting for a prolonged length of time. The risk of a DVT increases with the length of the flight. Your risk is also increased if you have additional risk factors such as a previous DVT or you are overweight. Your midwife or doctor will be able to check your individual risk.
What can I do to reduce the risk of a DVT?
If you are taking a short haul flight (less than four hours), it is unlikely that you will need to take any special measures. Your midwife or doctor should give you an individual risk assessment for venous thrombosis and advice for your own situation.

To minimise the risk of a DVT on a medium or a long haul flight (over four hours), you should:
• wear loose clothing and comfortable shoes
• try to get an aisle seat and take regular walks around the plane
• do in-seat exercises every 30 minutes or so – the airline should give you information on these
• have cups of water at regular intervals throughout your flight
• avoid drinks that contain alcohol or caffeine (coffee, fizzy drinks)
• wear graduated elastic compression stockings – your midwife or doctor will need to provide the correct size and type for you as they are different from standard flight socks.
If you have other risk factors for a DVT, regardless of the length of your flight, you may be advised to have heparin injections. These will thin your blood and help prevent a DVT. A heparin injection should be taken on the day of the flight and daily for a few days afterwards. For security reasons, you will need a letter from your doctor to enable you to carry these injections onto the plane.
Low-dose aspirin does not appear to reduce the risk of a DVT but you should continue to take it if it has been prescribed for another reason.

There are of course circumstances when you may be advised not to fly?

A medical condition or health problem can complicate your pregnancy and put you and your baby at risk. For this reason, if any of the following apply, you may be advised not to fly:

• You are at increased risk of going into labour before your due date.
• You have severe anaemia. This is when the level of red blood cells in your blood is lower than normal. Red blood cells contain the iron-rich pigment haemoglobin, which carries oxygen around your body.
• You have sickle cell disease (a condition which affects red blood cells) and you have recently had a sickle crisis.
• You have recently had significant vaginal bleeding.
• You have a serious condition affecting your lungs or heart that makes it very difficult for you to breathe.

It is important that you discuss any health issues or pregnancy complications with your midwife or doctor before you fly. If have an increased chance of miscarriage or ectopic pregnancy, ask for an ultrasound scan for reassurance before you fly.
Be aware that the unexpected can happen while travelling which could delay your return home. Some airlines may not allow you to fly if you have fractured a bone, have a middle ear or a sinus infection or have recently had surgery to your abdomen that involved your bowel, such as having your appendix removed.

Making a decision to fly:
To help decide whether or not to fly, think about your own medical history and any increased risks that you may have. The following questions may also help you in making your decision:

• Why do you want to fly at this particular time?
• Is your flight necessary?
• How long is your flight? Will this increase your risk of medical problems?
• How many weeks pregnant will you be when you travel and when you return?
(Your chance of going into labour is higher the further you are in pregnancy.)

It is also important to remember that having a miscarriage, whether you fly or not, is common (one in five) in the first three months of pregnancy.

• What are the medical facilities at your destination in the event of an unexpected complication with your pregnancy?
• Have you had all the relevant immunisations and/or medication for the country you are travelling to? Have you checked with your doctor how these affect your pregnancy?
• Does your travel insurance cover pregnancy and/or care for your newborn baby if you give birth unexpectedly? There is huge variation among airlines and travel insurance policies so it worth checking before you decide to fly.
• Have you discussed your travel plans with your healthcare provider and informed them that you are thinking about taking a medium or long haul flight?

What should you take with you?

• Your hand-held pregnancy notes
• Any medication you are taking
• If you are over 28 weeks pregnant, your airline may ask you to get a letter from your midwife or doctor stating when your baby is due and confirming that you are in good health, are having a straightforward pregnancy and are not at any increased risk of complications.
• Any document needed to confirm your due date and that you are fit to fly. Some airlines have their own forms/documents that will need to be completed at any stage of pregnancy. Contact your airline if you are unsure.
• Travel insurance documents

What about security scanners?

You will have to go through the normal security checks before flying. This is not considered to be a risk to you or your baby.

What about wearing a seatbelt?
You must wear a seatbelt. You should ensure the strap of your seatbelt is reasonably tightly fastened across the top of your thighs and then under your bump. Ask the cabin crew if you need a seatbelt extension.

Worse case scenario: You go into labour on the flight!
Any pregnant woman has a small chance of going into labour early or for her waters to break early. If this happens to you on a flight, there is no guarantee that other passengers or crew members will be trained and experienced to help you give birth safely. As a result, the pilot may have to divert the flight to get help for you. For this reason it is best to reserve air travel to necessity and to plan trips wisely.

Bon Voyage! 

Yours in health
Dr Leneque Lindeque (MBChB, FCOG(SA), Mmed (O&G)
Obstetrician and Gynaecologist
Netcare Alberlito Hospital
Tel: (032) 586 0723