Knocked up abroad: pregnant travel in the first trimester

pregnant travelFor more on pregnant travel, see parts 1 and 2 of Knocked up abroad: pregnancy in a foreign country here and here.

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.
Going to Russia in winter while pregnant may seem crazy to some, but for me it made sense: Moscow and St. Petersburg are a few hours from Istanbul by direct flight, my husband speaks fluent Russian in case of any problems, and there was no risk of malaria or eating any food that had spoiled in the sun. While it was cold and snowing during our trip and I couldn’t take advantage of some of Russia’s cold-weather remedies like vodka and saunas, a week in Moscow and St. Petersburg was a perfect mix of exotic and comfortable.

Nearly every cafe had a variety of non-alcoholic and caffeine-free beverages for me to choose from, I even had non-alcoholic sangria, mojitos, and mulled wine in addition to fresh juices and herbal teas. Both cities are beautiful to explore in the snow, with plenty of museums and cafes to warm up in, and the New Year holiday displays made it festive.

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]

Knocked up abroad: prenatal care and pregnancy advice in a foreign country

pregnancy foreign country See part 1 of Knocked up abroad: getting pregnant in a foreign country here.

One of the best parts of my experience so far with pregnancy in a foreign country has been the excellent medical care I have in Istanbul. Like many other expats before me, as soon as I took a positive pregnancy test, I called up the American Hospital for an appointment. The hospital treats many foreigners each year, is renowned for infertility treatment as well as other quality medical care, and is popular as part of Turkey’s growing medical tourism (the cow pictured at right is in the hospital lobby; you can tell how serious he is because of the glasses).

My first prenatal appointment was scheduled for Thanksgiving Day, and while many Americans were getting up to stuff the turkey, I confirmed I was six weeks’ pregnant (you’re welcome for sparing the “bun in the oven” puns). My very charming and English-speaking Turkish doctor gave me the usual pregnancy advice/warnings*, all peppered with only-in-Turkey bits:

  • Eat lots of dairy like ayran (yogurt drink Westerners often hate because it’s not sweet), yogurt, and cheese. While pregnant women should avoid unpasteurized milk and soft cheeses, you won’t find many of either in Turkey (or in the U.S.) unless you are looking for them.
  • No undercooked or raw meat like çiğ köfte, a popular raw meat and bulger-wheat snack served all over Istanbul (I first tried it outside a trannie bar here). I’ve discovered that the primary concern with sushi is an elevated risk for food poisoning; there is no additional or specific risk to the fetus. Sushi fish is often flash-frozen when caught, therefore it contains lower levels of bacteria. Use your judgment when ordering raw sushi, or stick to California rolls.
  • It would “be a crime to not eat fish in Turkey,” according to my doctor, but stay away from the big ones like shark which have high mercury levels. 1-2 servings of salmon or tuna per week is fine.
  • Sadly, especially in a country with excellent produce, eating unpeeled vegetables or salads in restaurants is a no-no, due to the hepatitis risk. While most restaurants are very clean in Turkey, when you are in a country with some traditional “natural-position” (aka squat) toilets still in use, you run the risk of some food contamination that’s riskier for expectant women than the general public.
  • Like many Europeans, I was told that 1 or 2 alcoholic drinks a week is okay, such as a glass of wine with dinner. Moderation and common sense are key, and it’s always best to err on the side of caution.
  • Caffeine is also fine in moderation: 1-2 cups of coffee, tea, or sodas are allowed per day, though I’m not convinced that a piping hot, two-sugars-no-milk glass of Turkish çay isn’t higher in caffeine than your average cup of tea.
  • Light exercise like yoga, pilates, and swimming are fine, but no “jumping exercises.”

My other concern was, of course, travel, but that was given the green light as long as I have no complications. Most airlines allow travel up to 28 weeks without a doctor’s note and up to 35 weeks with medical clearance. Whether your flight is short or long-haul, it’s advised to get up and move around every hour or so (good advice even for non-preggos) and choose the aisle seat. As I get bigger, I find puffing out my stomach as much as possible helps to get baggage assistance, and seats on the subway is good too.

The costs of prenatal care in Turkey are low: each of my appointments to a top-end private hospital cost just over $100 USD even with NO insurance (my U.S. insurance treats all international care as out-of-network and thus, out-of-pocket), even with ultrasounds at every visit–most American women get only a few over the course of the pregnancy. I’ll pay less for childbirth with a private room and catered meals for the family than I would for a shared room in a New York hospital. I rarely wait more than a few minutes to see the doctor, and the facilities and equipment are new and clean.

So far, Turkey has proved fairly easy to navigate as a pregnant person. I’ve never had a doctor who I could easily email with problems (such as which cold medicines were okay to take when I was sick in Russia), and everyone I meet is helpful with my concerns and questions. Istanbul is built on hills, so walking to the store can mean a fairly strenuous hike, but modern Turkey accommodates with online food and grocery delivery. Organic food is cheaper than at home, and nearly all of my cravings have been satisfied so far (though I could go for some American mac-and-cheese). I’m not yet halfway through the pregnancy but wouldn’t hesitate to reassure another expat that Turkey is a fine place to have a baby.

*Note: none of this is intended to be taken as medical advice, but rather my personal experience and anecdotal evidence. Talk to your own doctor about warnings and concerns before traveling to a foreign country, pregnant or otherwise.

Stay tuned for more on pregnancy travel, including Turkish superstitions and customs, where to travel in each trimester, what to eat when pregnant abroad, where to do pre-baby shopping, and more on having a baby in a foreign country. Check here for further updates.

Seven reasons cell phones kill people on road trips

distracted driving, cell phones road tripsEven though Thanksgiving is behind us, there are still plenty of reasons to road trip before the end of the year. Well, there’s one reason, really, and that’s Christmas. But, a lot of people are going to get behind the wheel or whine in the back seat. Of course, we can expect a lot of people to be on their cell phones while they’re driving about, according to the Insurance Information Institute’s blog.

Do the math on this: cell phone + car + stupidity = dead people

It really is that simple, but there are some reasons for this equation. In fact, even though I go over seven of them here, the Insurance Information Institute has pulled together an impressive list of distracted driving statistics and insights, and I just lost interest in making the list any longer than it already is (so I suggest you take a peek over on the institute’s blog) … but check out my stuff first:1. Distracted driving: the number of people killed in distracted driving incidents is up a whopping 22 percent from 2005 to 2009. Fortunately, not as many people seem to be dying from cell phone-impeded driving in the recent past, though.. The Department of Transportation reported a 6 percent decline in distracted driving deaths in 2009, which means people are either doing it less or have gotten better at it.

Of course, traffic crashes declined slightly overall for that period, which means the share of them belonging to distracted drivers actually increased. So, there’s no way to rationalize yourself out of this one: stay off the damned phone while you’re driving.

2. Leading cause: cell phones are the top reason for distracted driving, with a variety of perspectives considered. For the future though, texting appears to be the next big killer.

3. Texted to death: 18 percent of drivers in the United State have done it in the past 30 days, according to a recent study by the Insurance Research Council. Drivers 25 to 39 are most likely to be guilty: 41 percent of them copped to it, compared to only 31 percent of drivers 16 to 24.

4. Banning it does nothing: the Highway Loss Data Institute “found that texting bans may not reduce crashes,” writes the Insurance Information Institute. Collisions actually increased slightly in three of the four states examined (but the change was not statistically significant).

5. Complacency: teens are more ready to blame drunk driving than texting for traffic accident fatalities. According to the Insurance Information Institute: “The survey seems to indicates that despite public awareness campaigns about the dangers of distracted driving many teens still do not understand the risk.”

6. Hypocrisy: even though 62 percent of AAA Foundation for Safety survey respondents feel that cell phone use while driving is “a serious safety threat,” close to 70 percent admitted to talking on their phones. Twenty-four percent read or sent text messages.

7. Teenagers are stupid: while 84 percent said in a Seventeen magazine survey said “they were aware that distracted driving increased the risk of a crash,” writes the Insurance Information Institute, 86 percent engaged in distracted driving behavior related to a cell phone.

[photo by inhisgrace via Flickr]

Ten things to know about your destination before you go

know before you go travel planningSo you’ve chosen your vacation destination – booked the tickets, agonized over TripAdvisor to find a hotel, and bought the guidebooks or downloaded the apps. Whether you like to plan your itinerary in advance or play it by ear, there are a few things you should research in advance to make your arrival – and your trip – go smoothly.

From airport taxis to local laws to transit passes, what should you know before you go?

  1. Best way from the airport to the city – This should be your first order of business – figuring out the most efficient and/or least expensive way to get to your hotel before you find yourself being hounded by taxi touts at baggage claim or standing in the rain waiting for a bus that comes every two hours. London’s Heathrow Express is a great compromise between an exorbitant taxi ride and a long Tube ride with transfers, but other cities may have cheap cab fares (find out approximately what you should pay before you get in the car) or excellent public transportation systems connecting with the airport. Check out any guidebook or the Getting In section of a Wikitravel article for the best info and check if your hotel offers pick up service for a good value.
  2. How much cash to start with and in what denominations – Now that you know how to get to your hotel, you’ll need cash to pay for your transfer. No matter what the exchange rate, you should find out how much money to withdraw from the ATM or exchange at the airport (note: most airports in the world have ATMs and will give you a better value than exchanging currency, but it never hurts to have some backup cash). Lonely Planet‘s Cost Index is great for determining about how much cash will cover a taxi ride, a meal or two, and other expenses for your first day or so. Some countries will give you large bills that are hard to break – try entering an odd amount like 130 to get some smaller bills or visit a newsstand to get change.
  3. What’s the tipping culture – So you’re in the taxi, cash in hand to pay the driver, do you tip? In many countries, like Turkey, people don’t generally tip taxi drivers, perhaps rounding up to the nearest lira or two, so a 38 TL fare would cost 40 TL (taxi drivers here are so loathe to give change they may eat the cost of a 52 TL fare and give you change for the 50). Likewise for restaurants and cafes, 10% is standard in many places outside of the US and often included in the bill. I’ll never forget leaving a 20% tip on top of an included 10% in a London bar – the waitress was thrilled but I felt like a fool. Figure out what’s appropriate and do as the locals do to avoid stiffing or overcompensating for service.
  4. A few key phrases in the local language – This is a necessity in some countries, and always a courtesy to know a few words of a foreign language. “Please” and “thank you” and “where is the bathroom?” will always be useful, and “two beers,” “another one” and “check” will usually result in good things.
  5. When to leave for the airport when you depart – It’s hard to think about going home when you’re enjoying vacation, but knowing how much time to allow for your departure can help you to maximize your last day. While your airline might tell you how far in advance to arrive, better to ask someone who really knows how long to budget, like your hotel concierge. A Lisbon hotel front desk clerk once saved me several hours waiting at the airport by letting me know the recommended three hours before check-in was overkill.
  6. What’s legal – Learning about the local laws can save you headaches and money. I just discovered that in Warsaw, jaywalking is illegal and punishable by a 50 zl fine, hence why all the residents wait patiently at crosswalks for the light to change. In some cities, it’s fine to bring a bottle of wine or beer into a park for a picnic, but in others, public drinking can get you fined. Knowing what’s legal can also help you avoid (or seek out, depending on your proclivities) potential danger areas such as red light districts. Wikitravel is good at listing info on local laws and dangers.
  7. What days museums are free or discounted – Visiting a museum on a free day might allow you to see something you’d otherwise miss due to the admission price, and free nights are often packed with locals and fun events. Find out what days you can get free to help plan your itinerary. Rick Steves’ guides always have a good summary of free (as well as closed) days.
  8. The real value of a transit or tourist pass – Many cities have a museum or tourist card that you can purchase to get free admission at many sites for a set time. But before you invest in a pass, check out if you really want to go to the included places (cheesy sights like wax musuems are invariably included) and if you’d have enough time to really enjoy visiting them all. Similarly, public transportation passes can be great in a city like New York, where a Metrocard can save you time and money, but if you prefer to walk or cab around town, you might skip it. The single best deal I’ve found is the Japan rail pass, which must be purchased in your home country, and gives free or discounted access to public transit and many of the country’s awesome bullet trains.
  9. Where to get help if you need it – I used to think registering with the U.S. Department of State when traveling abroad was a bit silly but a friend at the embassy in Istanbul stressed how important it is in case of a disaster in locating citizens, as well as to help Americans abroad in trouble. Leave your travel details with friends back home, carry the contact details for your embassy and credit cards and check your insurance policy for coverage away from home.
  10. Can’t-miss tips from locals and travelers – Here’s where social media can really help you have a great vacation – before departure, ask your travel-savvy friends on Facebook and Twitter what their don’t-miss recommendations are for what to see or where to eat. Even if they are well-known attractions, having a tip from someone who’s been there will help you prioritize. You can always ask us at Gadling, chances are one of us has been there and can provide recommendations – just post to our Facebook page or send us a tweet @Gadling.

Other tips you’ve found handy to know in advance? Leave us yours in the comments.

Getting drunk: Twenty cities that don’t know how to handle their liquor

California loves to get wasted! San Diego and San Jose are the top two cities that drink stupidly, according to a survey by Insurance.com. They lead the country in alcohol-related driving violations, a dubious distinction to say the least. So, if you step into the crosswalk in these two spots, take an extra second to look both ways.

The reasons for hitting this list vary and include proximity to colleges and nightlife, and the presence of stringent enforcement may play a key role, the survey finds. If you think a lack of enforcement puts a city at the top of the list, remember that slapping the cuffs on a lot of people increases the instances of drunk driving, which actually pushes it up. Insurance.com explains:

San Diego most likely tops the list because its police departments are aggressive in making DUI arrests, and officers there arrest lots of drunk drivers, says Mark McCullough, a San Diego police department spokesperson specializing in DUI issues.

To pull the list of 20 drunk driving metropolitan areas together, according to Insurance Networking News, Insurance.com analyzed “percentage of its car insurance online quote requests for which users reported alcohol-related driving violations.”

So, who made the top 20? Take a look below:

  1. San Diego, CA
  2. San Jose, CA
  3. Charlotte, NC
  4. Phoenix, AZ
  5. Columbus, OH
  6. Indianapolis, IN
  7. Los Angeles, CA
  8. San Francisco, CA
  9. Austin, TX
  10. Jacksonville, FL
  11. San Antonio, TX
  12. Dallas, TX
  13. Houston, TX
  14. Fort Worth, TX
  15. Memphis, TN
  16. Philadelphia, PA
  17. New York, NY
  18. Baltimore, MD
  19. Chicago, IL
  20. Detroit, MI

Boston got lucky on this one. It was excluded because of a lack of data – not because the drivers there are absolutely nuts.

Disclosure: I learned how to drive in Boston.

[Via Insurance Networking News, photo by davidsonscott15 via Flickr]