Hi,

We came across this forum searching for information about travelling pregnant to Bali. Our exact situation is however not covered in the discussions, so we would like to ask for help.

We were arranging to escape the cold European winter by spending the next 5-6 months in Bali. Now it turns out my wife is pregnant in the 6th week and her doctor told her that we should skip Bali.... His reasoning is that she will not be able to get vaccinations, nor will she be able to take medicines without jeoprodizing the health of the new baby.

If there is someone who knows from experience about the dangers in travelling pregnant to Bali, please give us advice. We read in this forum that women in their 28th week travelled to Bali and survived so want a second opinion from a person who knows. Our doctor has never travelled to Bali or Asia in his life.

Any help is much appreciated.

Thanks

If you are not happy with the advice given from your own doctor, it would be better to seek out a doctor who has the specific knowledge of tropical medicine and pregnancy. I don't see that it matters whether he has been to Bali or not. Also, you check whether your travel insurance policy will cover you for all eventualities and emergencies and whether your airline will allow travel or has any special arrangements.

http://www.nhs.uk/Livewell/travelhea...pregnancy.aspx

Thanks Crellston,

The information from the link you gave us actually says it is not safe to travel before 12-14 week....

Any one flying and staying in Bali while pregnant in the first three months?

If your OB is clueless seek a second opinion from

an www.istm.com or other pro travel clinic near you.

Long Flights can be an issue many other issues.

Review www.mdtravelhealth.com Asia Bali and Travel

listed below.

Yellow fever

Yellow fever vaccine, which consists of live virus, should not in general be given to pregnant women. Unless absolutely necessary, pregnant women should not travel to areas where yellow fever occurs, which includes most of equatorial Africa and many parts of South America. If travel to these areas is unavoidable, yellow fever vaccine may be considered if the benefits of vaccination appears to outweigh the risks.


Malaria prophylaxis

In general, pregnant women should avoid traveling to areas where malaria transmission occurs. Malaria may cause life-threatening illness in both the mother and the unborn child. None of the currently available prophylactic medications is 100% effective. If travel to malarious areas is unavoidable, insect protection measures must be strictly followed at all times. The recommendations for DEET-containing insect repellents are the same for pregnant women as for other adults. Of the currently available drugs for malaria prophylaxis, chloroquine has the best safety record in pregnancy, but has lost its usefulness in many parts of the world. Mefloquine (Lariam) may be given if necessary in the second and third trimesters, but should be avoided in the first trimester. There are no data regarding the safety of atovaquone/proguanil (Malarone) during pregnancy, so the drug should be avoided pending further information. Doxycycline may interfere with fetal bone development and should not be given during pregnancy.


Travelers’ diarrhea

Strict attention to food and water precautions is especially important for the pregnant traveler because some infections, such as listeriosis, have grave consequences for the developing fetus. Additionally, many of the medications used to treat travelers’ diarrhea may not be given during pregnancy. Quinolone antibiotics, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin), should not be given because of concern they might interfere with fetal joint development. Data are limited concerning trimethoprim-sulfamethoxazole, but the drug should probably be avoided during pregnancy, especially the first trimester. Options for treating travelers’ diarrhea in pregnant women include azithromycin and third-generation cephalosporins. For symptomatic relief, the combination of kaolin and pectin (Kaopectate; Donnagel) appears to be safe, but loperamide (Imodium) should be used only when necessary. Adequate fluid intake is essential.

Iodine tablets should not be used for more than a few weeks during pregnancy, due to risk of congenital goiter. Bismuth compounds, such as Pepto-Bismol, should not be taken during pregnancy.


High altitudes

Travel to altitudes greater than 4000 meters (13,100 feet) should be avoided during pregnancy. During the third trimester and during high-risk pregnancies, travel should be limited to altitudes less than 2500 meters (8200 feet).


Air travel

Air travel is not advised during the last month of pregnancy or for seven days after delivery.


Summary of vaccines and pregnancy

Vaccines which should not be given during pregnancy:

Measles-mumps-rubella
Varicella
Yellow fever (may be considered if travel to high-risk area is unavoidable)
Vaccines for which safety data during pregnancy are not available:

Hepatitis A (no data, but risk in pregnancy thought to be extremely low)
Typhoid (Typhim Vi may be safest, since inactivated)
Japanese encephalitis (avoid travel to high-risk areas)
Vaccines which may be administered during pregnancy if indicated (avoid immunization during first trimester):

Hepatitis B
Rabies (human diploid cell)
Inactivated polio
Meningococcal
Tetanus-diphtheria
Influenza

For further information, see Planning for a Healthy Pregnancy and Traveling While Pregnant on the CDC website and Pregnancy and travel from the U.K. Department of Health.

Follow medical instruction precisely for best experience.

Do get an ok from a konowledgeable OB MD prior to travel.

http://www.mdtravelhealth.com/destin...asia/bali.html

health risk specific to Bali.

www.istm.org for quality travel clinics.

Thank you for the invaluable advice and links, qwovadis!

Indonesia is a country of 240 million souls, so obviously there are a lot of babies being born here. I'm not a doctor and would hesitate to hand out medical advice, but if it were my baby, I'd delay the trip and spend 5/6 months in Bali when your child is a toddler.

I did some rough traveling in Southeast Asia during my second trimester. This was 27 years ago and medical care was even worse than it is today. Everything turned out all right, but I don't know that I'd recommend it.

Some points to consider. I think the vaccination issue could be overcome. Some your wife may already have, some she won't need for Bali, some would be low risk. That would leave a short list to tackle.

You wouldn't want to travel to an undeveloped country without basic protection, though. Typhoid, hepatitis, tetanus, polio are critical. Malaria is optional and not a great risk in Bali. Dengue is problematic but there's no preventative anyway. Rabies is also a very real concern in Bali.

Emergency evacuation insurance is absolutely required. It's a good idea for anyone in Bali or any third world area. You don't want a close encounter with an Indonesian hospital. It's a 2.5 hour flight to Singapore, so if your wife does have a pregnancy related issue, it's not so easy to get fast attention.

Throughout pregnancy, even in the early stages, regular checkups are recommended. Although there are Western doctors and Western trained doctors in Bali, service is rudimentary and the level of medical practice isn't up to international standards. Diagnosis is especially unreliable.

For a long term stay, I assume you won't be staying in a five star hotel. You'll have to be extremely careful with water -- not just for drinking but for bathing and washing foods. Cholera is an ever present concern. Bacteria and parasites are found the world over, but in the tropics they are legion, and often difficult to shake.

Lastly, and equally important, is day to day living in Bali. Many women react poorly to heat and humidity while pregnant and it's hot and humid all the time in Bali. If this is a first pregnancy, it's difficult for your wife to predict how she will feel. The climate, the difficulty of getting around, the unfamiliar food and surroundings can be exhausting under any circumstances, and in pregnancy debilitating.

Marmot has given you good advice. I love Bali - I spent a month there and it was one of my all-time favorite destinations ever, but would NOT have wanted to be there while pregnant. Even if all is fine medically, your wife will need and want monthly check-ups and routine ultrasounds with someone she trusts. Many of the minor issues I had during my pregnancies would have been very worrisome had I been in Bali. Also, my traveling companion developed severe Bali Belly while there and ended up in an Australian clinic - would have been a nightmare had she been pregnant.

Yesterday we watched the movie "Eat, pray, love" with Julia Roberts (http://www.imdb.com/title/tt0879870/) and as you probably know, she spends the love part of the movie in Bali. There she got treatment by local doctors and I remembered the line: "This is better than antibiotic".

So I thought:

"Millions of people live in Bali/Inodnesia and even though the locals are better accustomed to the conditions there, they must also get sick from time to time. Obviously, not everyone has the money to visit Western standard hospitals and get a modern-day treatment.
So, they must go to local shamans/healers and get treated well with tradidional medicine methods...."

What do you think about it - can we look for a good local doctor and rely on him? Even here in Bulgaria, we use a lot on homeopathic treatment before resorting to antibiotics with our first baby.

Thanks again to all of you!

If the possible consequences of the trip affected only your wife and you, you could decide what risks you're willing to take. There's another life at stake here. Are you willing to take the chance of life long harm to your child, even if unlikely, just because you want this trip?

No! We actually decided to go to Mallorca Spain...
I hope we shall be safe there, right?

Haven't been to Mallorca, but I actually know a pre-natal cardiologist in Barcelona. I would imagine the quality of health care there is top notch. Sounds like a fantastic choice.