By Stacie Dunkle
“We don’t recommend international travel during pregnancy for first-time mothers,” said my nurse midwife. Those words stopped me in my tracks. As an officer in the Epidemic Intelligence Service with three years of experience working overseas, I couldn’t believe what this nurse was telling me. Rarely a month went by that I wasn’t waiting in a security line at the airport. “Why?” I asked. I was up-to-date on all of my vaccines, even yellow fever, which I knew shouldn’t be given during pregnancy, and I was well-practiced in methods for staying healthy in developing countries (wearing seatbelts and avoiding untreated drinking water, food from street vendors, raw vegetables, etc.). I began to wonder how I was going to break the news to my supervisor that I wouldn’t be able to conduct the investigation we were planning in Nepal in two weeks. We had been preparing for over a month. Our colleagues on the ground were ready to go, and my plane tickets were already booked.
When my partner and I decided to have a baby, I knew that once our little one arrived, my life would change dramatically. There would be no more hopping on planes to far-off places during public health emergencies—I’d have to think about who would watch my baby and how I’d cope with potentially missing all those precious moments with him. Still, the decision was easy since I had always wanted to have children and I was finally at a point in life when the timing felt right. Pregnancy can be a difficult thing to plan, of course, so when it did happen, somehow it still felt unexpected. Even more unexpected was how much my life was suddenly changing before the baby had even arrived.
My trip to Nepal was planned toward the end of my first trimester and I hadn’t yet broken the happy news to my supervisor, since you never know what might happen during those first few months. Luckily my symptoms up to that point were limited to mild morning sickness and fatigue. When the nurse explained that the region in Nepal I was planning to visit was endemic for chloroquine-resistant malaria and plopped CDC’s Health Information for International Travel (aka the “Yellow Book”) down in my lap, I realized it was time to share my secret.
“You’ll be taking a big risk,” the nurse said. “You can’t take any of the drugs we usually prescribe to prevent malaria.” Although most pregnant women can take a drug called mefloquine to prevent malaria, I couldn’t take it because of my personal health history. I wasn’t just thinking about myself anymore; I also had to consider my baby. Because of the serious risk associated with getting malaria during pregnancy, I decided it was best to cancel my trip.
Of course, my supervisor was very understanding. He had been planning to travel to Nepal as well, and with his guidance, our partners were able to carry out the investigation on their own. Although I was disappointed to not participate fully, I changed my focus to health issues that were closer to home and still traveled quite a bit. During my second trimester, I flew to Mexico, Ohio, Michigan, Canada, Arizona, and Florida. It’s too bad I couldn’t get double the frequent flyer miles while traveling for two! During these flights, I avoided lifting heavy baggage, always requested an aisle seat, and was careful to drink plenty of fluids and walk around every 30 minutes or so. Of course, the latter was no problem since I had to use the restroom that often anyway! I enjoyed traveling while pregnant and laughed thinking that my baby would be born already familiar with the sound of jet engines and having memorized the safety features aboard aircrafts.
The Home Stretch
When my third trimester arrived, I was offered an opportunity to travel to Lima, Peru to attend a training summit. It would be a valuable trip for me professionally because it would provide background for a project I was working on. I would be able to network with colleagues and focus my work to make it more useful to them. When I looked at the dates for the trip, I realized I would be 33 weeks pregnant upon departure and staying for a little over a week. I hesitated because many physicians don’t recommend traveling after 32 weeks, and most airlines restrict travel after 36 weeks for single, uncomplicated pregnancies. I was fortunate to have been very healthy during pregnancy and decided the trip was worth the risk, but swore I would cancel if any concerns came up before departure.
I still took a number of precautions before I committed to traveling. These included getting approval from my certified nurse midwife and reviewing CDC’s website of “Health Information for Travelers to Peru.” My biggest concern was premature delivery in an unfamiliar country where Spanish is the primary language. My experience with Spanish is limited to high school classes and a few weeks traveling in Spain and Mexico. If I had to ask anything more than, “Dónde están los baños?” I would be out of luck; that included trying to describe symptoms I might be experiencing to a doctor. Fortunately, I have a friend who had just recently moved back to the US after living in Lima for a year. She was able to provide local English-speaking contacts and recommended an obstetrician and hospital where I could receive care. I also checked to make sure my health insurance would cover any medical expenses I might have had while travelling.
The trip to Lima was relatively uneventful with regards to my health. I was more nervous and uncomfortable than I had expected to be, though. My feet were swollen, and the fatigue from my first trimester returned with a vengeance. I did my best to keep up with the demands of work and getting to know as many people as I could. Peruvians are much more considerate of pregnant women than we are here in America. During a city tour, I saw a sign for a pregnant lady parking spot and at the airport, as we were waiting in line to check in, one of the airline staff asked me if I wanted a wheelchair. Initially, I was embarrassed and refused, but after standing and waiting with my luggage for nearly an hour, I longed for the wheelchair. We took an overnight flight home, and as I paced up and down the aisle with swollen legs, unable to get any sleep while most of the other passengers snoozed away, I couldn’t wait to get home. Finally stepping off the plane was a huge relief.
To everyone’s surprise, I went into labor six days later. My mind raced with questions. Will my baby be healthy arriving at 35 weeks? What would have happened if I had gone into labor in Peru without the support of my loved ones? After reviewing my medical records, my midwife predicted that my due date was off by at least a week and I was closer to full term than we had originally thought. My son was born the following night, completely healthy, into the loving arms of his mother, father, and grandparents. The question I kept asking myself was: if I had it to do again, would I have travelled so far knowing I was so close to delivery?
Although the trip had a number of professional benefits, I probably would do things differently. As I had known from the beginning, my life changed dramatically after having children. The first change I observed in myself as a new parent was that my tolerance for risk went down the moment I looked into my son’s eyes. International travel is risky at any point during pregnancy, since both travel and pregnancy can be unpredictable. Although CDC and health care providers can provide knowledge, guidance, and recommendations, it is up to each mother to balance the benefits and risks and decide what is best for herself and her child.
What do you think?
We want to hear from you. Have you traveled during pregnancy or had to pass on a trip because you were expecting? How has being a parent changed your career?
If you would like more information on traveling during pregnancy please visit http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-8-advising-travelers-with-specific-needs/pregnant-travelers.htm