This section provides answers to typical questions asked of midwives in relation to travel. The section is divided into subject areas, within which is a range of travel-related questions midwives may be faced with. Click on a question to see the model answer.

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	Pregnancy and travel		Immunisation and medication		Legislation and restrictions
	Insurance		Destinations to avoid		Planning for emergencies
	Altitude sickness		Specific diseases and risks during pregnancy		Symptoms to be concerned about
	Medical records

Pregnancy and travel

	Is it safe for me to travel while I am pregnant?
	Now that I am pregnant, are there any special precautions I should take before I travel?
	Now that I’m pregnant, is there anything that I should take on holiday in addition to what I would normally pack?

Is it safe for me to travel while I am pregnant?

Most pregnant women have a trouble-free journey, however, a pregnancy can never be guaranteed to be uneventful (in medical terms). If a situation arises in which you need medical attention then obviously, it would be better if you were at home. The medical expertise may not be available where you are staying and there may be a lack sterile equipment and blood. Also, the people involved in your care that are familiar with your medical history, such as your GP and myself [community midwife] will not be available. There may also be language difficulties, and treatment may cost a lot of money. For this reason, it is wise to choose a destination that will keep these problems to a minimum.

That said, travel during an uncomplicated pregnancy, is generally considered safe. However, it is recommended that pregnant women try to limit their travelling to the second trimester, when the risks of miscarriage and early labour are at their lowest. An added bonus is that it will also be less uncomfortable during this time.

You should also know that many airlines and cruise ships have restrictions on travel in the third trimester of pregnancy.

Now that I am pregnant, are there any special precautions I should take before I travel?

You should choose your destination carefully. Destinations that require you to be immunised against diseases should really be avoided wherever possible, as should areas such as malarious regions that require you to take preventative medication. You should also be more careful about hygiene-related issues because some foodborne illnesses, such as listeria can be far more serious during pregnancy.

You should avoid excessive flying. Although flying in pregnancy is generally considered safe, there have been studies that showed that pregnant women who flew more than 74 hours per month had a higher rate of miscarriage. If you are flying, you should make arrangements for your comfort. For example, try to get seats with more legroom, plan to walk in the aisles and drink lots of water. On longer flights, you should really wear flight socks to minimise the risk of deep vein thrombosis (DVT).

Now that I am pregnant, is there anything that I should take on holiday in addition to what I would normally pack?

You will need a letter from me, or your doctor, if you are flying in late pregnancy. This should give your due date and confirm that you are fit to fly. You should also take with you your maternity notes, in case you need treatment for any pregnancy-related problems while you’re away. You should take any medication prescribed by your doctor and you may also need to carry a note from your doctor explaining what the medication is and why you have been prescribed it. You should also take a copy of your travel insurance details and the helpline number. It would also be a good idea to find out the contact details of a local doctor or hospital. If you are travelling within the UK, NHS Direct will be able to give this information. If you are going abroad, you may have to check the internet. Your travel agent may also be able to help.

Immunisation and medication

	I was vaccinated against yellow fever and polio before I went on holiday. I found out that I was pregnant after I’d had the vaccinations and now I’m really worried.
	If I decide to go somewhere that requires immunisation is this a problem?
	We want to go to Egypt, but I’ll have to take antimalaria drugs. Is this ok in my condition?
	Are there any holiday vaccines that I can’t be given because I’m pregnant?
	I get travel sick. Is there anything that I can take to prevent this?
	I like to take diarrhoea treatments with me on holiday. Is there anything that I can take now that I’m pregnant?

I was vaccinated against yellow fever and polio before I went on holiday. I found out that I was pregnant after I’d had the vaccinations and now I’m really worried.

It is recommended that wherever possible women who are pregnant do not receive vaccinations, however, neither yellow fever, nor oral polio vaccines, have been shown to cause damage to the unborn baby. I hope that this has reassured you, but you should really speak to your GP.

If I decide to go somewhere that requires immunisation is this a problem?

There is a risk that a vaccine may damage the unborn baby. Therefore all vaccines should really be avoided wherever possible in pregnancy. If you travel to a destination and don’t have the recommended vaccinations, you are at risk of contracting the disease. I would therefore advise that you consider holiday destinations that do not require immunisations, particularly live vaccinations such as yellow fever. If you are unable to avoid travelling to areas that require immunisation, then it may be decided that vaccination is appropriate if the risk of the vaccine is outweighed by the risk of the infection itself. You need to discuss any potential immunisations with your doctor.

We want to go to Egypt, but I’ll have to take antimalaria drugs. Is this ok in my condition?

It really is best to avoid travelling to malarious regions. However if you can’t avoid travelling there, you will need to use antimalaria treatment. I know that chloroquine and proguanil can be used safely in pregnancy, but you should speak to your doctor about this.

Guidelines for malaria prevention in travellers from the United Kingdom can be found on the Health Protection Agency website. Click here for more information.

Are there any holiday vaccines that I can’t be given because I’m pregnant?

There is a theoretical risk that a vaccine may damage the unborn baby. Therefore all vaccines should really be avoided wherever possible in pregnancy. Although it is not recommended that yellow fever, rubella, BCG and oral polio vaccines are given during pregnancy, there is no evidence that they cause harm to the unborn baby. If the risk of infection is considered high enough and vaccines have to be given, then it is best that we wait until the second and third trimester to do so. There are inactive, injectable forms of the typhoid and polio vaccines, which may be more appropriate in pregnancy.

I get travel sick. Is there anything that I can take to prevent this?

Wherever possible you should avoid taking drugs. However, if you suffer badly from travel sickness it is possible to take cyclizine (tradename Valoid), promethazine (tradename Phenergen) and chlorpheniramine (tradename Piriton) in pregnancy, although you should always follow the manufacturer’s instructions. It is important that you avoid taking diphenhydramine (tradename Medinex), particularly during the first and third trimester.

If you are thinking of taking any drugs to treat travel sickness, check with the pharmacist that it is suitable to do so.

I like to take diarrhoea treatments with me on holiday. Is there anything that I can take now that I’m pregnant?

A lot of drugs that are usually taken for diarrhoea are not recommended in pregnancy. Lomotil can be used with caution, although you should seek advice from your doctor on this. Codeine should be avoided in the third trimester and, incidentally, during labour. You can still take rehydration formulations such as Dioralyte, which will prevent dehydration caused by diarrhoea.

Legislation and restrictions

	Will the airlines allow me to fly?
	I’ve heard you need a doctor’s letter to be able to fly. Is this true?
	I want to go to Singapore before the baby comes and I heard that getting a visa might be a problem. Is this true?
	Will I have a problem getting a visa for other countries?

Will the airlines allow me to fly?

Air travel in the last four weeks of pregnancy and within one week of delivery is not recommended. Most airlines, therefore, do have some sort of policy when it comes to pregnancy and air travel. These vary between airlines so you should check with the airline you’re flying with. Airlines don’t usually restrict travel until quite late on in pregnancy. One of the reasons for travel restrictions is the risk that you may go into labour during the flight. As a result, most airlines place restrictions on travel in pregnancy from around 36 weeks, although they can start from as early as 28 weeks, so it is important that you check.

Many airlines will also not let you fly if you are within a week of your due date (although again, this may vary). You should also be aware that some airlines have restrictions on travel after the birth, both for you and your baby.

I’ve heard you need a doctor’s letter to be able to fly. Is this true?

Most airlines require a doctor’s note saying that you’re fit to travel if you are 36 or more weeks pregnant. However, you should find out what your airline’s policies are, as this can vary, and some airlines require a doctor’s letter as early in the pregnancy as 28 weeks. The doctor’s note should be written within a certain time of you flying (often between 72 hours and 1 week). This varies between airline companies, so again, you should check with your airline.

I want to go to Singapore before the baby comes and I heard that getting a visa might be a problem. Is this true?

No, pregnant women can get a visa to enter Singapore, however, if you are planning to go there when you are over six months pregnant, you have to get a letter from your doctor confirming that it is safe for you to travel. You must also get a Social Visit Pass for Expectant Mothers before you go, which you can apply for at the High Commission or Embassy. You will need to submit your application in person in order to declare that you are pregnant. This is because all women between 15 and 45 years old must declare, in person, whether or not they are pregnant when they submit their visa application.

Will I have a problem getting a visa for other countries?

No, you shouldn’t have a problem, but you should find out if there are any specific requirements as a result of your pregnancy. You can find out about visa requirements from the Consulate or Embassy of the country you are planning to visit. Their telephone numbers are available through Directory Enquiries, or you could check with your travel agent.

Insurance

	Can I still get travel insurance while I’m pregnant?
	I want to go on holiday before the baby comes. Do you know if travel insurance would cover any problem with my pregnancy while I’m away?

Can I still get travel insurance while I’m pregnant?

Yes you can get travel insurance, however there may be some clauses that affect your cover. It is important that you read the terms and conditions of your policy so you are aware what is and isn’t covered. You should also declare that you are pregnant at the start so that you don’t receive cover that is invalidated by the fact that you are pregnant. The later you are in your pregnancy, the harder it is to get travel insurance.

I want to go on holiday before the baby comes. Do you know if travel insurance would cover any problem with my pregnancy while I’m away?

Many insurance companies will only provide cover if you return home before you are 32 weeks pregnant, and others specify that you should return even earlier. You should read the terms and conditions of the policy you take out carefully as pregnancy can invalidate some insurance policies. If your insurance company does not provide cover after a certain time in your pregnancy, it means that although you could still claim for any losses unrelated to your pregnancy, you would be unable to make a claim for anything that was pregnancy-related (for example if you had to cancel your holiday because of a pregnancy-related reason).

You should also check that the care of a premature baby is covered, should you go into early labour while you are on holiday. You may need to arrange separate additional cover for this.

If you have an annual policy, you should call your insurer for advice on its rules. You may need to take out a single policy if they won’t provide cover.

Destinations to avoid

	I want to go to Thailand. Is this ok?
	I want to book a holiday before the baby comes. Is there anywhere I should avoid?

I want to go to Thailand. Is this ok?

Thailand is a malarious area (that is, you are at risk of catching malaria if you go there). There are some areas in which there is multi-drug resistance, including border areas of Thailand. Other areas are the borders between Cambodia and Myanmar. In these areas, P. falciparum (which is a highly drug resistant type of malaria) infections do not respond to normal antimalarial treatment with chloroquine or sulfadoxine–pyrimethamine. The treatment which would otherwise be used in these circumstances, doxycycline or atovaquone/proguanil, cannot be given to pregnant women. Therefore you should really avoid travelling to these areas.

Guidelines for malaria prevention in travellers from the United Kingdom can be found on the HPA website. Click here for more information.

I want to book a holiday before the baby comes. Is there anywhere I should avoid?

If at all possible you should avoid going to:

Planning for emergencies

Is there anything that you think I should do before I go on holiday in case of emergency?

Is there anything that you think I should do before I go on holiday in case of emergency?

There are a number of things that you should do before you go.

Altitude sickness

I’ve been invited to go to Huancayo in Peru and it’s quite high up. Is it ok to do this while I’m pregnant?

I’ve been invited to go to Huancayo in Peru and it’s quite high up. Is it ok to do this while I’m pregnant?

In the later stages of pregnancy it is particularly important to avoid areas where oxygen levels are low, which includes areas that are at high altitudes. Pregnancy at high altitudes is thought to affect the growth of the baby. It is also associated with pregnancy-related high blood pressure. Ideally, if you are not used to living at high altitudes, you should avoid going to such areas. It has been recommended by some authorities that pregnant women should not travel above 2500 metres in the first three months of pregnancy.

Specific diseases and risks during pregnancy

	I’m going to Turkey and I’ve been told that I need to be immunised against hepatitis A. Is this a problem?
	I’m going on holiday and I’ve been told that I need to be careful about hepatitis E. What exactly is it and what can I do to prevent catching it?
	I think that where I’m going on holiday is a malarious region. Is this going to be a problem?
	I found out I was pregnant after I came back from holiday. I’ve been taking the antimalaria drugs mefloquine and doxycyline. I am now quite worried about the effects on the baby.
	Someone told me I need a polio vaccine before I go on holiday. Can I have this during pregnancy?
	I’m going to Peru on holiday and I know that I could catch typhoid. I’ve heard of it, but I don’t know exactly what it is and if there is anything I can do to prevent it?
	I’m going on holiday and I’ve been told I need a certificate saying that I have received the yellow fever vaccine. I’m not sure if I can have the vaccine or not so I don’t know what to do.
	What is yellow fever and how can I prevent it, without the vaccine?

I’m going to Turkey and I’ve been told that I need to be immunised against hepatitis A. Is this a problem?

Hepatitis A (automatic link to Childhood Diseases website) is the most common traveller’s infection that can be prevented through a vaccine. The vaccine is inactive. Therefore, although it is recommended that vaccines be avoided where possible in pregnancy, it can be given in pregnancy if it is considered that the risks of infection justify it. You should speak to your GP about this.

I’m going on holiday and I’ve been told that I need to be careful about hepatitis E. What exactly is it and what can I do to prevent catching it?

You can usually catch hepatitis E from contaminated drinking water and food, although it can also be caught by faecal–oral transmission from person to person. You should therefore be careful in areas with poor sanitation and hygiene. If possible, it is best to avoid these areas.

The disease itself is similar to hepatitis A (automatic link to Childhood Diseases website). In pregnant women, however, hepatitis E is much more severe than hepatitis A, with a death rate of around 20%. If you’re going to a region where you may be at risk from hepatitis E, you should follow the general precautions for avoiding potentially contaminated food and drinking water. These are (as listed in chapter 3 (PDF format) of the World Health Organization publication International travel and health):

I think that where I’m going on holiday is a malarious region. Is this going to be a problem?

Malaria in pregnancy is generally more severe, and can result in abortion or stillbirth as well as complications in you. Ideally, pregnant women should avoid these areas. However if you can’t avoid travelling there, you should use antimalaria treatment and I know that chloroquine and proguanil can be used safely in pregnancy. Although as a rule, mefloquine shouldn’t generally be used in pregnancy, recent studies suggest that it is safe in the second and third trimesters. If you really can’t avoid going to a region where there is a risk of highly drug-resistant malaria, mefloquine can be used cautiously in the second and third trimesters. (It may also be safe in the first trimester, although this is yet to be confirmed). You should speak to your GP about this.

You shouldn’t just rely on the preventative drugs, you should also take precautions against mosquito bites, such as covering up and using mosquito nets at night. You can use insect repellents, but you must make sure you read the manufacturer’s instructions as some (such as those containing DEET, or diethyltoluamide) should be used sparingly.

You should be aware of the symptoms of malaria and ensure that you have a blood test for malaria parasites urgently if you develop a fever of 38°C or more. You should try to avoid situations in which stand-by treatment (which is not recommended in pregnancy) is needed, and as such, you should try not to venture further than 24 hours from medical help. If this is not possible, you can, in emergencies, take quinine for seven days, although you should still seek medical help as soon as possible.

Further information on other preventative measures can be found in chapter 3 (PDF format) of the World Health Organization publication International travel and health.

Guidelines for malaria prevention in travellers from the United Kingdom can be found on the HPA website. Click here for more information.

I found out I was pregnant after I came back from holiday. I’ve been taking the antimalaria drugs mefloquine and doxycyline. I am now quite worried about the effects on the baby.

Ideally, pregnancy should be avoided during the period of drug intake and for three months after mefloquine and one week after doxycycline prophylaxis has stopped. You should really speak to your doctor about this, but I hope I can offer some reassurance in that evidence so far has not shown mefloquine to cause abnormalities in the unborn baby.

Someone told me I need a polio vaccine before I go on holiday. Can I have this during pregnancy?

The oral polio vaccine is a live vaccine, and as such should be avoided if possible. If it is considered that the risk of infection outweighs the risk from the vaccine, then you should probably receive it. It is better if the vaccine is given in the second or third trimester. There is also an inactivated injectable form, which may be considered more suitable in pregnancy. You need to speak to your GP about this to see what course of action is recommended. Although it is recommended that the oral polio vaccine is not administered in pregnancy, it has not been shown to cause damage to the unborn baby.

I’m going to Peru on holiday and I know that I could catch typhoid. I’ve heard of it, but I don’t know exactly what it is and if there is anything I can do to prevent it?

Peru, along with parts of north and west Africa and south Asia is the area in which travellers are most at risk of catching typhoid. It is caught from contaminated food or water. You should therefore take precautionary measures to prevent it. Such measures, as listed in chapter 3 (PDF format) of the World Health Organization publication International travel and health include:

The disease itself can vary in severity. Severe cases start with a gradual onset of fever, headache, general feeling of unwell, loss of appetite and insomnia. Untreated, it can lead to a number of complications, including pneumonia and it can even be fatal.

There is a vaccine for typhoid that can prevent the disease. As with all vaccines, however, it is best to avoid administering it in pregnancy. If the risk of infection justifies the vaccination then it can be given. You need to speak to your doctor about this.

I’m going on holiday and I’ve been told I need a certificate saying that I have received the yellow fever vaccine. I’m not sure if I can have the vaccine or not so I don’t know what to do.

The yellow fever vaccine is not recommended in pregnancy. However, it is a requirement for entry into some countries. If a yellow fever vaccination certificate is required purely for entry purposes, a certificate of exemption will normally be sufficient. If, however, it is considered that the risk of infection outweighs the risk fro