The arguments for grounding a female pilot during the third and final trimester of pregnancy range from the difficulty of finding a suitable uniform, to the hazards of going into labor during a trip. No matter, few women, if they had the choice, would choose to continue with the typical airline pilot flight schedule during their last weeks of pregnancy.
Remarkably, the FAA has stayed completely out of the pregnancy issue up to this point. As long as a woman does not have any medical condition or take any medication that is listed as a grounding item, there is no reason why she cannot fly when pregnant. As an added assurance, however, many women time their visits to the Airman Medical Examiner (AME) so that they are not pregnant the day they receive their medical certificate or renewal. By doing so—as long as no other disqualifying conditions pop up during the course of the pregnancy—they avoid dealing directly with the issue. That's a little tricky if you hold a first class medical, which must be renewed every six months. Unless the FAA decides that pregnancy poses a safety of flight problem, however, it is a non-issue.
Of course, many AMEs see very few pregnant pilots and are confused about how to handle a pregnant woman seeking a medical. Dr. Warren Silberman, with the Civil Aviation Medical Institute in Oklahoma City, Oklahoma, says it doesn't have to be that way. "Yes, you can fly when pregnant. They [AMEs] are confused because all they need to do is look into their guide for AMEs to see that [the medical application] is not to be deferred. If there is a problem with the pregnancy, then there is a problem. The guide says that closing in on the third trimester there may be problems with comfort, fitting the seatbelt, using controls, and AMEs might note this. If [AMEs] are confused, they are not using the sources available to them to give them the information."
For airline pilots who are experiencing a normal pregnancy, calculating sick leave and vacation, disability pay, and, in some cases, even unpaid maternity leave can be the most challenging part about working while pregnant. Getting dressed in the morning may come in a close second. Many airlines have no particular maternity uniform for pilots. One UPS pilot simply wore dark maternity pants and her shirt untucked in the latter days of her pregnancy, and some military pilots have been seen wearing their husbands' flight suits as their silhouettes "round out."
Quite a few women find that the single largest obstacle to flying while pregnant is their obstetrician. The risks of flying to the fetus are nearly unstudied. Anecdotal evidence and small-scale studies present conflicting and inconclusive evidence, and this can be confusing to physicians who are not familiar with the whole body of literature on the subject. Most of the studies to date have been done on flight attendants who spend a large portion of the flight standing and serving. Even they have been found to have no higher risk of miscarriage than the general population (see "Pregnancy Outcomes Among Female Flight Attendants," Daniell, et. al., Aviation, Space and Environmental Medicine; September 1990).
One perceived risk for pregnancy loss is the lack of oxygen above 10,000 feet. Veteran gynecologist and obstetrician Dr. Allan Shevach of Fort Myers, Florida, says, no way. "Studies have shown that the fetus already lives with an oxygen saturation level around 60 percent-about what you'd have if you were breathing the air on the top of Mount Everest. The lack of oxygen in an unpressurized airplane at altitude is far less of a worry to me than, say, the risk of a bladder infection from not voiding during a long cross-country flight or the risk of contracting phlebitis from sitting in one position for hours at a time," he says.
Another valid concern to physicians is cosmic radiation exposure from repeated flights at high altitudes. "In-flight cosmic radiation poses a small but definitive risk to the frequent flyer," says Donald S. Geeze, M.D., M.P.H., in his article "Pregnancy and In-Flight Cosmic Radiation" (see Aviation, Space and Environmental Medicine, vol. 69, No. 11; November 1998). The risk of having a sick or developmentally disabled child increases from 41 chances in 680 (standard population) to 42 chances in 680, according to at least two major studies published in 1990 and 1998. The National Institute for Occupational Safety and Health (NIOSH) was set to begin collecting data in 1999 that will include the reproductive health and history of female flight attendants compared to teachers. This large-scale study should help clarify some of the risks involved in working aloft while pregnant.
Before you decide to ground yourself for the duration, however, hear this. In his book, The Invisible Passenger: Radiation Risks for People Who Fly, author Dr. Robert J. Barish states that there is at least as much evidence that says that any genetic damage that would cause infertility or congenital defects is done long before flying parents conceive their first child. The radiation that humans are exposed to on repeated flights above 35,000 feet is as damaging to their gametes over time as it is to their fetus. "The radiation issue is something that should concern everyone," says Dr. Jacque Boyd, aviation consultant and author of the study "Pregnancy and the Female Pilot: History and Review of Current Administrative Policies and Procedures." "The problem also has as much impact on males as females. It goes way beyond the maternity issue," she says.
Even if you're flying unpressurized aircraft or passengers for a living, a normal pregnancy shouldn't impinge on your regular flying routine too much. Kim Brown, a private pilot with 300 hours, logged nearly 75 of those hours while pregnant with her second child, Reed. "There were days when I didn't feel like flying, so I didn't," she says, wrestling the squirming, healthy, red-headed toddler on her lap. "I'll never forget climbing out of the airplane after my first dual cross-country and puking all over the ramp," she says with a laugh. "When I got bigger, I pushed the seat back and extended the seatbelt. With my long legs I could do that in the Cessna 172." Brown took her private pilot oral and practical examinations at around 32 weeks of pregnancy, well into the third trimester. "My instructor called around to find an examiner who wouldn't be uncomfortable flying with me. Fortunately I didn't have to fly far for the test, and once it was over, I stopped flying until Reed's delivery about two weeks later," she says. "No one told me to stop flying; I just knew it was time."
Normal light airplane flying isn't likely to create any problems during a normal pregnancy. Aerobatic flying, however, may be different. The G forces encountered during aerobatic flight have an unknown effect on the developing fetus and on the risk of miscarriage. The rapid pressure changes associated with steep dives and climbs, likewise, have an unknown effect on the overall health of the pregnancy. Again, there is no conclusive evidence that flying aerobatics is a problem. There is also no evidence that it is not. Consider aerobatic flying the way you'd consider the warning sign outside every large roller coaster in the United States, and then decide for yourself.
Even though pregnancy itself is no reason to stop flying, there are plenty of moments during a pregnancy when your physical state may not be up to the challenges of being airborne. If you experience temporary severe fatigue, morning sickness, or hormone-induced emotional stress, then it is not a good time to be in the air as pilot in command. There is also, for some, the issue of size. If your children round out your physical shape with the adeptness with which they round out your personality, you may find yourself too large to pull the yoke or control stick completely aft. Once you can no longer get full control throw in the cockpit, it is time to get out for a bit. Finally, if you have any medical problems during the pregnancy, including gestational diabetes, your medical certificate is no longer valid and you must legally ground yourself, no matter how competent you may feel about your ability to fly safely.
Perhaps the best and the worst news for women who fly and are considering flying while pregnant is that no one will tell you what to do. "I think [flying while pregnant] is a common-sense issue. I have always felt my job in this whole arena for the last 10 years is to provide the information," says Dr. Boyd. "What the pilot decides to do with the information is between her, her doctor, and her company," she continues. "I really do think that the women who have used the information I've provided in my studies have put themselves and their children's health first. I don't see any problem [with flying while pregnant] as long as the woman is in good contact with her obstetrician and knows herself well in the flight environment."
The most daunting issues you may have to confront as a pregnant pilot, especially one who flies professionally, are the attitudes of your fellow crewmembers. Most of the men you fly with will be startled the first time they notice your pregnancy (no more startled, however, than passengers boarding your flight). Don't be surprised if crewmates seem a little overprotective or downright frightened to fly with you. Multiply that tenfold and you are approaching the trepidations of your passengers. Their terror will pass, however, when they see that your protruding belly has not significantly warped your piloting prowess.
Capt. Pterodactyl has retired now, so you are unlikely to encounter his attitude on the flight deck. It doesn't hurt, however, to keep your pregnancy to yourself for as long as you are able. Even in the less complicated world of general aviation, pregnant pilots are rare birds indeed. Women pilots in general have found that flying is easier if we spend precious little time calling attention to our differences. If you need a little counseling, contact the International Society of Women Airline Pilots (ISA+21), the Women in Corporate Aviation Network (WECAN), Women in Aviation, International (WIAI), Women Military Aviators (WMA), or The Ninety-Nines to find someone who has been in your shoes.
Parenting and piloting is undoubtedly a tough, glorious, and somewhat bumpy road to ride in life. Even those with the best preparation are in for a surprise or two. The best defense against problems for any parent, pre- or postpartum, is a combination of common sense and education, and that's no different than what it takes to fly an airplane. That must mean that pilots make good parents. I don't know. Ask my kids. Oh, and good luck.
Women In Aviation, Intl.
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AOPA members can call the Pilot Assistance Hotline at 800/USA-AOPA for more information.