With her baby due in June, Meghan Markle has been unable to fly to the UK for Prince Philip's funeral.
Pregnant with her and Prince Harry's second child, whom they revealed during their recent interview with Oprah Winfrey to be a girl, the former actress, 39, has been advised by her doctor not to fly.
Even given the heightened precautions all travellers are taking when flying during the pandemic, advice given to expectant mothers can differ from doctor to doctor, not to mention from airline to airline. There are also additional things to be considered, such as taking into account pre-existing conditions, multiple pregnancies and the healthcare available in the country of arrival.
If you're pregnant and thinking about booking an overseas holiday or visit, here are some things to consider before you do ...
What are the guidelines?
“It’s not advisable to fly after 37 weeks of pregnancy in a single pregnancy and after 32 weeks if you are carrying twins,” says Dr Shruti Garg Indoriya, a specialist obstetrician and gynaecologist at Dubai London Clinic. “All airlines have their 'fit to fly' rules for pregnant women, which need to be confirmed before travel, and they will require a travel certificate from their doctor after 28 weeks of pregnancy.
"These guidelines are shared by health organisations for clinical practice and public health policy," she says. "They are shared through the respective websites and journals which are published and updated from time to time."
While there are many medical reasons restricting travel in a pregnant woman's third trimester, other factors to consider include complications, energy levels and comfort.
“In most cases, pregnant women can travel safely until 36 weeks of pregnancy. But travel may not be recommended for women who have pregnancy complications, such as recent vaginal bleeding, severe sickle cell disease or lung problems,” says Dr Shachi Joshi, a specialist in obstetrics and gynaecology at Dubai's Medcare Medical Centre, JBR.
“The best time to travel is mid-pregnancy, from 14 to 28 weeks. During these weeks, your energy has returned, morning sickness is improved or gone, and you are still able to get around easily. After 28 weeks, it may be harder to move around or sit for a long time.”
Early labour, DVT and complications: The risks of flying during pregnancy
There are many instances of women giving birth on planes. In May 2019, a woman on a flight from Riyadh to Manila went into labour, causing the pilot to decide on an emergency landing in Hyderabad, India. In September 2020, passenger Hiyam Nasr Naji Daaban gave birth on EgyptAir flight MS777 from Cairo to London. The pilot diverted the flight to Munich, Germany, and the baby girl received free flights for the duration of her life.
“Any pregnant woman has a small chance of going into labour early or for her waters to break early,” says Dr Joshi. “This probability increases once the woman has completed 36 weeks. If this happens to you on a flight, there is no guarantee that other passengers or crew members will be trained and experienced to help you give birth safely.”
While premature birth is a concern, more often the restrictions are based on the risk of developing or and exacerbating pre-existing conditions.
"There is a risk of deep vein thrombosis (DVT) on long-distance flights that are more than four hours," says Dr Indoriya. "High-risk pregnancy conditions such as placenta previa, preeclampsia or twin pregnancies can have complications during the flight, which can't be managed during travel and can risk the mother and the baby's lives."
While most guidance follows the same lines and time constraints, rules can differ from airline to airline, so you should check before you fly.
Etihad Airways does not require a medical certificate until a woman reaches 28 weeks for single or multiple pregnancies. From weeks 29 to 36, a medical certificate is required to fly, while travel is not permitted past week 37 for single pregnancies. For multiple pregnancies, a medical certificate is required from weeks 29 to 32, with travel not permitted after week 33.
On Emirates, pregnant women can fly up to 29 weeks without a medical certificate, but require one post-week 29. Travel is restricted at week 36 for single pregnancies and week 32 for multiple pregnancies.
Ensuring comfort in the air
There are plenty of ways pregnant women can maintain comfort in the air, as well as minimise the risks associated with flying.
“Dress comfortably in loose clothing and comfortable shoes,” suggests Dr Joshi. “Try to get an aisle seat and take regular walks around the plane and do in-seat exercises every 30 minutes or so."
Dr Joshi also advises drinking plenty of water, keeping your seatbelt on at all times in case of turbulence – "The belt should sit low on your hip bones, below your belly" – and wearing compression socks to prevent deep vein thrombosis.
Importantly, avoid lifting heavy luggage. “Staff and airline personnel are available to assist you with lugging those heavy bags around so you don’t have to,” she says. “Let your airline know in advance if you need assistance with your luggage or getting to the gate.”
While staying healthy in the air is important, it’s also worth being aware of the healthcare options available to you at your destination.
“The woman needs to have travel insurance and be sure there are suitable health services available at the destination in case of an emergency,” advises Dr Indoriya.
“She should also carry all her medical records in case she needs to see a doctor at the destination.”