It's a common question - am I safe to fly? Usually the answer is yes, but there are a number of things that you need to be aware of...
Let's start with the least likely of problems - air crashes. The risk of this happening as we all know is pretty low - a mortality rate of between 1 in 400,000 and 1 in 10 million, depending upon the airline you choose. A daily flight for about 1000 years before you can expect a problem (OK, it's a pretty big one if it does happen...) Not bad statistics really, compared to car travel for example (1 in 5000), although that is an US figure, the risks of car travel may be different in NZ.
Premature labour
A study published in the Australia & NZ Journal of Obstetrics & Gynaecology last year suggested that there may be a link between air travel and going into premature labour. Although they did find a link, it was only in first time mothers and resulted in an average gestational age of 36 weeks at birth, as opposed to 39 weeks in those who did not fly. There are a number of other factors that they were not able to take into account (whether women smoked or not, a history of infertility and infections - all of which can put you at higher risk of early delivery), so questions still remain. Interestingly, although women went into labour a few weeks earlier than normal, the flights actually took place on average at 11 weeks of pregnancy - 6 months or so before then. As the authors say, more research needs to be done (as always).
If you were thought to be at high risk of early labour, an ultrasound scan of the cervix (right) can help predict the possibility. If the cervix is more than 2.5cm long, it indicates that early labour is much less likely.
Thrombosis
Deep Vein Thrombosis (DVT) or a Pulmonary Embolism (PE) in the lung are pretty serious and have been in the news re their association with flying, coining the term 'economy class syndrome'. Unfortunately, just being pregnant puts you at higher risk than average. I think it is fair to say that the jury is still out on the exact link between air travel and thrombosis, but there are certainly some things that you can do to reduce the risk.
It is important to drink plenty of fluids, but not alcoholic ones for obvious reasons. Keep mobile during the flight, with regular short trips (as if you need to be told with all those fluids and your pregnancy bladder!). Graduated compression stockings are recommended for women who fly long distance during pregnancy. Some recommend low dose aspirin, but compression stockings are just as effective.
If you have additional risk factors for thrombosis (e.g. a strong family history or a prior thrombosis yourself) then you may need injections to thin your blood. Talk to your LMC about it if you are unsure.
Radiation exposure
This is one of the main reasons that airline companies transfer pregnant flight attendants to ground duty in the first trimester. A transatlantic flight is approximately the equivalent of 2 chest x-rays radiation exposure. This may lead to approximately 1/350,000 additional risk of childhood cancer for the baby. To put this in perspective, the background or 'natural' chance is around 1 in 650 - so although it sounds serious, the additional risk is actually quite small.
Low oxygen
It is true that the oxygen concentration in aircraft is less than on the ground (equivalent to an altitude of 2400m) but the level is more than enough for the baby. A woman who is quite severely anaemic, however, might develop symptoms and need additional oxygen. Your blood count would have to be less than 80 g/l which is not that common, even in pregnancy.
Other things to think about
Finally there are a number of practical things to consider when you are thinking about flying, some relating to where you are going.
- Vaccines - inactive ones are safe, but if the risk of infection is high, even the live ones might be preferable to the disease itself.
- Malaria - chloroquine is known to be safe and unless you are travelling to an area known to be resistant, this would be the recommended anti-malarial.
- Emergencies - for the duration of your flight, you will obviously have minimal access to medical equipment and possibly no access to doctors or midwives (...I am of course available for accompanied flights to the Maldives, Fuji, etc!). In reality the chance of something happening mid-air is pretty small, especially if you are less than 36 weeks.
- Medical care at your destination - are they able to provide a similar level of care to that in NZ?
- Insurance - check you are covered for both yourself and neonatal care - a trip to the US could prove very expensive if you did give birth early and weren't covered.
- Activities at your destination - swimming, walking, hiking etc are all safe, but beware of altitude activities as emergency services may be limited. This is apart from the risk of injury.
- Scuba diving - not recommended during pregnancy and definitely no deeper than 18 metres.
So, once you've got all that covered - have a great trip!
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