Baby on Board? Pregnant passengers should ask their doctor — not their airline — whether it’s safe to fly. And by the way, where is the baby a citizen?

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The birth of a baby girl on board a Cebu Pacific flight last week made international headlines and was met with well wishes and an airline gift of one million frequent flier miles for the baby.

Despite delivering several weeks before her due date, the mother and baby are reportedly doing well. The flight crew nevertheless decided to divert the Dubai to Philippines flight to Hyderabad, India, to ensure proper medical care for the newborn.

The in-flight premature birth raises important questions about the safety of flying during pregnancy, and whether the mother should have been flying. After all, there are some risks to flying while pregnant, including being forced to give birth in-flight, without access to modern medical care.

But my review of the in-flight birth cases reported in the media over the past two decades revealed that in most cases the mother went into labor prematurely, meaning that these flight emergencies are not due to moms flying just before they are scheduled to deliver. In many cases these women have visited their doctors and been approved to fly; the baby just comes early—often one to three months early. In one case the woman had no idea she was even pregnant.

Here are some facts you need to know before you fly while expecting.

Airlines make the rules

Cebu Pacific’s policy states that after the 34th week of pregnancy, expectant mothers must present a physician’s note indicating the passenger is “fit to fly.” The passenger must also fill out airline documentation. So while this mother may have been technically flying in conformity with airline policy, the stress of a long-haul flight, or dehydration or other factors, some of which are still medical mysteries, may have contributed to the premature birth, putting both mother and baby at risk.

In the United States, the FAA does not prohibit pregnant women from flying at any time during pregnancy, leaving airlines to set their own policies and procedures for pregnant passengers.

According to the Mayo Clinic, it is generally considered safe to fly before week 36 of pregnancy for women who have had healthy pregnancies. Women who have experienced complications during pregnancy are advised not to fly, or to limit total flight time.

No matter how far along in pregnancy, expectant women should discuss their travel plans with their physician to determine whether air travel is safe. Where the health of the unborn baby is concerned, it’s always better to be safe than sorry.

A close call

While the mom and baby on Cebu Pacific had a happy ending, my own experience would have had a very different ending. When I was expecting my daughter, I was then Inspector General of the Department of Transportation and had a very heavy work, travel and speaking schedule.

At month seven, I was slated to fly from Washington, D.C., to Guadalajara, Mexico to speak at a conference on bogus aircraft parts. My flight wasn’t until the later part of the day, but that morning I had the feeling that something was not right. Before heading to the airport, I stopped at my obstetrician’s office to get checked by my doctor – mostly to allay my concerns – but also to get the green light to travel.

I did not travel that day, nor for two and a half months thereafter.  In fact, I did not come out of the hospital until the end of July.

As it turns out, my decision to see my doctor that day was critical. I was in preterm labor and rushed to Georgetown University Hospital where I was confined, mostly on my left side, for two and a half months, only emerging when I got to carry home a healthy baby girl.  Had I flown that day, I would have been in labor and my precious daughter would not have survived. I am thankful that I had the right instinct – to double check with my doctor – something all pregnant women should do before boarding a plane.

Airline policies for pregnant passengers

As of today, here are the policies in place for pregnant travelers at some of the major airlines. As always, check first with your physician, then your airline, before making your travel plans.

Air Canada: A woman with a normal pregnancy and no previous history of premature labour may travel up to and including her 36th week on Air Canada and Jazz.

Alaska Airlines: Alaska Airlines does not have any restrictions or specifications for women traveling when pregnant. However, the airline suggests consulting a physician prior to any air travel.

American Airlines: If your due date is within 4 weeks of your flight, you must provide a doctor’s certificate stating that you’ve been recently examined and you’re fit to fly.

British Airways: For your and your baby’s safety you cannot fly after the end of the 36th week if you are pregnant with one baby or the end of the 32nd week if you are pregnant with more than one baby. After 28 weeks you must carry a confirmation from your doctor or midwife, such as a letter or certificate, in addition to your pregnancy record. This should be written within 7-10 days prior to travel and confirm your approximate due date, that you’re fit to travel and that there are no complications with your pregnancy.

This letter covers you for your entire journey, unless there are any complications with your pregnancy that requires medical intervention. Only then, would you be required to obtain an updated letter from the doctor that treated you.

Delta Air Lines: Delta does not impose restrictions on flying for pregnant women, so a medical certificate is not required to travel. Keep in mind, however, that ticket change fees and penalties cannot be waived for pregnancy. If you’re traveling after your eight month, it’s a good idea to check with your doctor to be sure travel is not restricted.

Frontier Airlines: Passengers who are pregnant are urged to consult with their doctor on whether it is safe to travel by air, including with due consideration to the possibility of turbulence, cabin pressurization, significantly increased risk of deep vein thrombosis associated with pregnancy, and lack of ready access to medical care. This is particularly important for women in their ninth month of pregnancy, who are urged to obtain an examination from their physician shortly before flying to confirm that flying by air will be safe. Women with a history of complications or premature delivery should not fly if pregnant. By traveling with Frontier, pregnant women acknowledge and accept these risks.

Hawaiian Airlines: If you’re pregnant and in good health, not experiencing medical complications or distress and not planning to travel within seven days of your due date, then you’re good to fly with us.

If you are not in good health or are in distress, then for your safety we may not allow you to board your flight. A Hawaiian Airlines airport customer service agent may consult our medical advisor to determine whether you’re fit to travel.

JetBlue: Pregnant Passengers expecting to deliver within seven days are prohibited from travel, unless such Passenger provides a doctor’s certificate dated no more than seventy-two (72) hours prior to departure stating that the Doctor has examined and found the Passenger to be physically fit for air travel to and from the destinations requested on the date of the flight and that the estimated date of delivery is after the date of the last flight.

Southwest Airlines: While air travel does not usually cause problems during pregnancy unless delivery is expected within 14 days or less, in some cases, traveling by air has been known to cause complications or premature labor. Female Customers at any stage of pregnancy should consult with their physicians prior to air travel. Southwest Airlines recommends against air travel beginning at the 38th week of pregnancy. Depending on their physical condition, strength, and agility, pregnant women may, in some cases, be asked not to sit in the emergency exit row.

Spirit Airlines: Women in their 9th month of pregnancy are urged to obtain an examination from her physician shortly before flying to confirm it is safe for them to travel.

Qantas Airways: After 28 weeks, you need to carry a certificate or letter from a registered medical practitioner or registered midwife confirming:

  • the estimated date of delivery;
  • whether it is a single or multiple pregnancy;
  • that your pregnancy is routine and that there are no complications.

The certificate or letter must be available on request and be carried with you at the airport and during the flight in your cabin baggage.

If you do have complications with your pregnancy, Medical Clearance is also required.

Flights 4 hours duration or greater

For routine pregnancies, you can travel up to the end of the 36th week for single pregnancies and the end of the 32nd week for multiple pregnancies (e.g. twins).

Flights less than 4 hours duration

For routine pregnancies, you can travel up to the end of the 40th week for single pregnancies and the end of the 36th week for multiple pregnancies.

Note: Qantas does not represent that travel is safe for you at any particular point during your pregnancy. You must seek advice from your own medical practitioner prior to your flight. The periods referred to above are only our minimum requirements.

Country Specific Requirements for Pregnant Passengers
Some countries place limitations on the entry of non-national pregnant women. It is best to check with the local consulate to confirm their country specific requirements.

United Airlines: Any woman in the first eight months of pregnancy will be allowed to travel on a United flight without medical documentation.

A woman traveling during her ninth month of pregnancy must have the original and two copies of an obstetrician’s certificate, which must be dated within three days (72 hours) prior to her flight departure. To best assure the pregnant traveler’s safety, it is preferable to have a certificate dated within one day of flight departure.

The certificate must state that the obstetrician has examined the customer and found her to be physically fit for air travel between the specified dates. The estimated birth date of the baby must be after the date of the last flight on the itinerary.

The customer should provide the original certificate to a United Representative at check-in. The remaining copies are for reference during air travel.

When a baby is born 3 miles above earth, where does the child get citizenship?

As in most questions posed to lawyers, the answer is: “It depends.”

The first question is what is the plane flying over?  If it is over a country or a country’s territorial waters, then it depends if that country decides citizenship based on right of the soil or the right of blood.  The U.S. is right of the soil—if you are on U.S. soil or within the 12 mile territorial limits, a newborn becomes a U.S. citizen. Some countries, like Great Britain and Japan, recognize the right of blood – you get citizenship if your parent or parents are citizens.

But what if a baby is born flying high above international waters which no country can claim?  In as early as 1944, with the Convention on International Civil Aviation, the United Nations seemed to suggest that a baby born on a flight is a citizen of where the airline is registered. The airline’s registration, called flagging, identifies the nation under whose laws it operates. It’s like a little piece of that country stuffed in a metal tube.  And, under the 1961 Convention on the Reduction of Statelessness, a birth on a ship or aircraft, in or above international waters where the child would otherwise be without a country, is a birth in the country in which the aircraft is flagged, or registered.

More often, however, these issues don’t come up because most nations recognize the baby as being a citizen of the nation of the mother, or parents, or in countries where mothers don’t have equal rights, the father.

And that result is also one of practicality. For the baby born on Cebu Pacific, I hope she can share those frequent flier miles with her mom.

I wish them all the best … and hope those frequent flier miles don’t expire.