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Key takeaways

• Always discuss your travel plans with your midwife or doctor.
• Get travel insurance that covers pregnancy and newborn care.
• Carry your maternity notes with you wherever you go.
• Check airline policies for flying limits and 'fit to fly' letter requirements.

Before you go: essential preparations

Before you travel, it is important to take some practical steps. This will help ensure a safe and comfortable journey for you and your baby.

Discussing your travel plans

Always discuss your travel plans with your midwife or doctor. This is especially important if you are thinking about a medium or long-haul flight. If you have any pregnancy complications, check that there is no medical reason to stop you from flying. Examples include high blood pressure or a risk of a blood clot in a deep vein (deep vein thrombosis, or DVT).

If you are planning a holiday, seek health advice as early as possible. Flying is not harmful to you or your baby. However, you should discuss any health issues or pregnancy complications with your midwife or doctor before you fly.

Travel insurance

You should always have travel insurance that covers any medical costs. It should also allow you to cancel for any issues related to your pregnancy. Inform your insurer that you are pregnant before you travel. If you do not, your insurance may not be valid. Make sure your travel insurance covers you for any eventuality. This includes pregnancy-related medical care during labour. It should also cover premature birth and the cost of changing your return trip date. Outside the UK, you might need to pay for healthcare. An EHIC or GHIC might not cover all healthcare costs. It also will not pay if you need to be brought back home if you are unable to travel yourself.

Your maternity notes

It is a good idea to have access to your maternity notes. This is in case you need medical help while you are away. You can ask your midwife how to access your notes if you are unsure.

Carry a paper or digital version of your maternity notes with you wherever you go. This ensures doctors have relevant information if needed.

Fit to fly letter

If you are over 28 weeks pregnant, your airline may ask for a letter. This letter should be from your midwife or doctor and needs to state your baby's due date.

It also confirms you are in good health and your pregnancy is uncomplicated. Some airlines have their own forms that need to be completed at any stage of pregnancy. Contact your airline if you are unsure about their specific requirements. Most airlines will not let you fly if you are within about a month of your due date. Keep in mind that you may have to pay for the letter and wait several weeks to get it.

Getting there safely: tips for every mode of transport

Whether you are taking short car journeys or flying abroad, take extra care of yourself. Planning ahead and making a few small changes can help ensure a comfortable and safe journey.

Air travel

The safest time to fly if you are carrying one baby is before 37 weeks. If you are carrying an uncomplicated twin pregnancy, it is before 32 weeks. Most airlines do not allow you to fly after 37 weeks.

It is important to check with your airline before flying. It may also be more difficult to get travel insurance after 37 weeks.

Common discomforts during air travel

You may experience some discomfort during flying. These can include:

• Swelling – of your legs due to fluid retention (oedema).
• Nasal congestion – you are more likely to have a blocked nose during pregnancy.
• Ear problems – changes in air pressure can cause problems in your ears.
• Pregnancy sickness – if you experience motion sickness, flying can make it worse.

Going through a full body security scanner is not considered a risk during pregnancy. A seatbelt must still be worn on planes.

Ask for a seatbelt extension from a flight attendant if you need one. It's good to remember that flight crews are not trained to deliver babies, which is why airlines have rules about flying late in pregnancy.

When you may be advised not to fly

You may be advised not to fly if:

• You are at an increased risk of going into labour before your due date.
• You have severe anaemia. This is when your red blood cell level is lower than normal.
• You have recently had significant vaginal bleeding.
• You have a serious heart or lung condition that makes breathing difficult.

Deep vein thrombosis (DVT)

A blood clot that forms in a deep vein in your leg or pelvis is known as a deep vein thrombosis (DVT). During pregnancy and for up to six weeks after birth, you have a higher risk of developing a DVT. There is an increased risk of DVT while flying due to sitting for a long time.

The risk increases with the length of the flight. Your midwife or doctor can check your individual risk.

How to reduce your DVT risk

To reduce the risk of DVT on a medium or 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.
• Have cups of water at regular intervals throughout your flight.
• Cut down on drinks that contain caffeine, such as coffee or fizzy drinks.
• Wear graduated elastic compression stockings. Your midwife or doctor can provide the correct size and type.

Heparin for high-risk travellers

If you have other risk factors for DVT, you may be advised to have heparin injections. These reduce the risk of a blood clot.

A heparin injection should be taken on the day of the flight and daily for a few days afterwards. You will need a letter from your doctor to carry these injections onto the plane for security reasons.

Car travel

It's important to take extra care when travelling by car to keep you and your baby safe. It is legal to drive when pregnant.

If driving, the seat should be as far back as possible while still managing all controls. Your chest should be at least 25 cm (10 inches) away from the steering wheel. You may need to recline the seat or tilt the steering wheel.

Airbags should still be used in pregnancy. Check with the car manufacturer about the minimum distance between you and the airbag.

Seatbelt safety

It is safest to wear a seatbelt. Place the lap belt below your bump so it catches your hip bones.

The cross belt goes between your breasts. The belt should not press on your bump.

If a long journey is necessary, plan breaks to get out and move around. For long trips, it is recommended to travel with someone. You could also share the driving with your companion.

Drink regularly and eat natural, energy-giving foods like fruit and nuts. Keep the air circulating in the car. Wearing compression stockings on long car journeys (more than 4 hours) can help prevent blood clots.

Train and coach journeys

Tiredness and dizziness are common during pregnancy. Drink plenty of water and eat healthy snacks.

Do gentle exercises like wiggling your toes and rotating your feet regularly to reduce stiffness. As with aeroplanes and cars, compression stockings are recommended on journeys over 4 hours to reduce the chance of blood clots.

Ferry or cruise travel

Some ferry companies do not allow sailing after 32 weeks of pregnancy. This can be 28 weeks for high-speed crossings. Check the ferry company's policy before you book.

For longer boat trips, such as cruises, find out if there are onboard medical facilities. Also, check for medical services at the docking ports.

Motion sickness may be more common in pregnancy. If you are already experiencing pregnancy sickness, travel can make this worse. To lessen travel sickness:

• Focus on the horizon or a distant object.
• Aim to be in the most stable part of the vehicle. This is over the plane wing, in the middle of a seagoing vessel, or the front seat in a car.
• Fresh air may help. Open a car window, go on the deck of a vessel, or use the fan on an aeroplane.
• Frequent light snacks may be better than a heavy meal.

Health and safety at your destination

When you arrive at your destination, it is important to continue taking care of your health and safety.

Food and water safety

Take care to avoid food- and water-borne conditions, such as stomach upsets and travellers' diarrhoea. Some medicines for treating these are not suitable during pregnancy.

Always check if tap water is safe to drink. If in doubt, drink bottled water. If you get ill, keep hydrated.

You should also continue eating for your baby's health, even if you are not hungry. Avoid uncooked or unwashed foods that could carry germs.

Typhoid is a serious illness caught through contaminated food and drink. Pregnant women may be more likely to catch typhoid and experience complications. Typhoid is common in India, Southeast Asia, and Africa. Vaccination is usually recommended for travellers to these regions.

Even with vaccination, take strict precautions to avoid contaminated food and water. This includes:

• Drinking only bottled water.
• Avoiding ice in drinks.
• Avoiding raw fruits and vegetables.
• Choosing hot (cooked) foods.
• Washing hands frequently with hot, soapy water.

Managing in hot climates

You may find hot, sunny weather uncomfortable during pregnancy, even if you normally love it. It can also make it hard to sleep.

Wear comfortable shoes and socks. Rest with your feet up as much as you can. Drink plenty of water; this helps your body get rid of excess water.

Heat exhaustion and heatstroke

Know the signs of heat exhaustion and heatstroke. Symptoms of heat exhaustion include:

• Dizziness and confusion.
• Loss of appetite and feeling sick.
• Excessive sweating and pale, clammy skin.
• Cramps in arms, legs, and stomach.
• Fast breathing and pulse.
• Temperature of 38°C or above.
• Intense thirst.

If you show signs of heat exhaustion, move to a cool, shaded place. Lie down with your feet up and drink plenty of water to rehydrate. Cool yourself with a fan or cool water spray.

You should start to feel better within 30 minutes.

When to seek emergency help

Heatstroke is a medical emergency. Call 999 if you are no better after 30 minutes, or if you:

• Feel hot and dry.
• Are not sweating even though you are too hot.
• Have a temperature that has risen to 40°C or above.
• Are breathing rapidly or have shortness of breath.
• Are confused.
• Have a fit (seizure).
• Lose consciousness or are unresponsive.

Vaccinations and preventative measures

You will need vaccinations before travelling to certain countries. There are some vaccinations you should not have when pregnant, especially in the first three months.

Always check before you book anything. Non-live (inactivated) vaccines are safe to use in pregnancy.

Most vaccines that use live bacteria or viruses are not recommended during pregnancy. This is because there is a small chance they could affect your baby. However, some live travel vaccines may be considered if the risk of infection outweighs the risk of vaccination.

Live vaccines include:

• BCG – for tuberculosis.
• MMR – for measles, mumps, and rubella.
• Oral typhoid – for typhoid fever.
• Yellow fever – for yellow fever.

If there is a high risk of infection in the area you are travelling to, it is often safer to have a vaccine. Most diseases will be more harmful to your baby than a vaccine. Ask your GP or midwife for advice about specific travel vaccinations.

Malaria

During pregnancy you are more likely to get malaria, and it can be more severe. It is a serious illness that is spread by mosquitos that can affect both your health and your baby's. Malaria mainly affects countries in Africa, South and Central America, Asia, and the Middle East.

If possible, avoid travelling to these areas if you are pregnant. If you cannot postpone your trip, preventative treatment is available. This involves taking antimalarial medicine tablets. Some anti-malaria tablets are not safe in pregnancy, so ask your GP for advice.

Travelling to areas with Zika virus

Zika virus is mainly spread by mosquitoes in some parts of the world. It's important to be aware of this. Getting the virus during pregnancy can cause serious problems for your baby’s development, including birth defects.

It is not recommended to travel to parts of the world where the Zika virus is present when you are pregnant or if you are planning to get pregnant. This includes:

• parts of South and Central America
• the Caribbean
• the Pacific islands
• Africa
• Asia

Check the risk for your destination country before you travel.

There are currently no vaccinations for malaria or Zika virus.

Preventing insect bites

Take steps to stop getting bitten by insects:

• Use mosquito repellent suitable for pregnancy.
• Cover skin as much as possible with long trousers, socks, and long-sleeved tops.
• Use a mosquito net at night.