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Knocked up abroad: pregnant travel in the first trimester
There's no question that having a baby changes you: your body, your lifestyle, even your shoe size. One thing I hoped not to change altogether was traveling, as long as it was reasonably safe and comfortable for me and the baby. From the beginning of my pregnancy in Istanbul, my doctor has okayed travel, as long as I get up to stretch frequently on flights and try not to overdo it. Most doctors (and mothers) agree that the second trimester is the most comfortable time for pregnant travel but the first trimester can be a good time as well (while you can still squeeze into pre-maternity clothes and walk without waddling) with a little extra precaution and a little more babying (of the mother, of course).
The first trimester of pregnancy is a tricky time for many women: the risk of miscarriage is highest up to 10 weeks, morning sickness is common, and hormones are running wild. It's too early to tell anyone outside family or close friends and without a visible belly, it's impossible for strangers to tell as well. At later points in your pregnancy, a baby bump acts as the international symbol for pregnancy and can make it much easier to express your condition when traveling abroad. If you travel in the early months before showing, you may want to learn the local language words for "I'm pregnant" to avoid a Bridget Jones-esque "mit kinder" scene if you need extra help while traveling.
Over this past December, my husband and I were looking for a good trip to take over the holidays, when I was around 10 weeks pregnant. Our location in Istanbul changes the list of short-haul destinations considerably from what we would have considered from New York, and we debated between a warm-weather beach destination (husband) or a snowy and "Christmassy" European city (me). We ruled out Egypt (not warm enough and not Christmassy), New Zealand (even less convenient to get to than from New York), and Sri Lanka (not enough time to plan properly and some risks of disease I couldn't be vaccinated against). In the end, we chose...Russia.
If you are planning a trip to a foreign country while pregnant, it makes sense to keep in mind the following guidelines. Always discuss plans with your doctor before booking and err on the side of caution when choosing a destination.
Check airline restrictions - Most airlines allow pregnant women to fly internationally up to 28 weeks, after which you must provide a doctor's note issued within a week or so of departure. 35 weeks (earlier for women carrying multiples) is the cutoff for nearly all airlines to prevent women from giving birth on board. Most US domestic carriers will allow pregnant women to fly up to the final month; hilariously, Continental will not let women board if "physical signs of labor are present" though they don't specify what.
Consider travel insurance - If your medical insurance doesn't cover you overseas, you may want to look into supplementary medical travel insurance, but be sure it covers pregnancy as many policies do not. Additionally, if you are traveling to a country where English is not spoken, you may want to research the name of a clinic or doctor in case of emergency as well.
Be prepared for jet lag - Before pregnancy, I had little issues with jet lag, trying to get on local time as soon as possible. I discovered when flying back from the US to Turkey that it hits you much harder as a pregnant traveler, especially as you can't use sleeping pills or alcohol to help you sleep. Factor this into your schedule and give yourself plenty of time to acclimate and adjust to time changes.
Realize your limits have changed - On a usual trip, I'd be up early to walk around a city all day, have a late lunch (or maybe just a big afternoon beer) followed by more museums and exploration, and still be up for checking out the local nightlife. Once pregnant, I required more sleep and three solid meals a day (plus maybe some snacks, I am eating for two!), tired after walking short distances, and was ready to call it a night long before last call. If you have an itinerary, pare it down to the must-sees and double the time to see everything; better to take it easy and enjoy your trip than feel exhausted and sick.
Look for destinations that don't require vaccinations - One of the first tests your doctor will give you after confirming pregnancy will be for immunizations to hepatitis and rubella. If you haven't had the vaccines, they will have to wait until after the baby is born as they are not safe for pregnant women. I have not had the hepatitis vaccine yet, and thus have a greater risk of contracting it, which rules out much of Africa and southeast Asia for travel, but also means I must avoid raw vegetables including salad in Istanbul. Most other medications and vaccines commonly given to travelers before going to an area prone to Malaria, Typhoid or Yellow Fever are not advised for pregnant women. But there's still a big world out there, check the CDC for destination-specific information.
Be extra aware of food and water safety - Pregnant women are more susceptible to food poisoning the average person, as the immune system is suppressed so it doesn't reject the fetus. This is the reason most pregnant women are told to avoid sushi and food that is not prepared in sanitized conditions. Even adventurous eaters should play it safe while pregnant and drink bottled water when in doubt. I recently had an opportunity to visit Mumbai, India but after consulting with a few friends who had lived there, I worried I'd spend the trip inside my hotel room eating pre-packaged food. Again, check the CDC and use the same common sense you'd use anytime while traveling: stick with food that is freshly prepared in restaurants full of people.
Stay tuned for more on pregnancy travel, including Turkish superstitions and customs, travelling in the second trimester, where to do pre-baby shopping, and more on having a baby in a foreign country. Check here for further updates.
[Photo courtesy Mike Barish from the Istanbul tram]