What Your OB May Not Be Telling You About Driving While Pregnant

You are about to be a parent. You are getting as prepared as possible. You are eating right and staying away from foods that could be harmful to your baby. You are shopping for things like bedding and an infant car seat.

You know once that baby is born you are required by law to protect your infant, buckling her into properly installed a rear-facing child restraint. Are you required by love to protect the baby in your womb?

Did you know that the fetus of a pregnant woman has been shown to be at 5x the risk of a 0 to 1 year old infant in the same car using standard, mandated restraint systems?

Recent studies predict anywhere from 700 to 5,000 pregnancies are lost every year due to motor vehicle crashes. Even on the low end, that is almost 6x the average of 120 infants who die in car crashes every year. That's an incredible figure.

At this point you may be asking, "why such a wide range?" The reason is because only deaths to fetuses over 20 weeks gestation are required to be recorded and even then the reporting isn't consistent. Sometimes a pregnant women is in a minor "fender bender", doesn't miscarry until weeks later and the connection is never made.

A study by the University of Michigan estimates that on average, 2.9% of women report being hurt in a "car accident" during pregnancy. Based on an average of 4 million babies born a year, that's 116,000 crashes where a mom-to-be is injured, at least somewhat.

The risk of adverse fetal injuries, such as placental abruption, uterine rupture, maternal death or fetal loss, in a low speed 16 MPH frontal crash at 28 weeks gestation is 26% for belted drivers and 70% for unbelted drivers.

What if we could lower the numbers?

There are a lot of factors affecting safety in the car during pregnancy. Some of these factors include: simple exhaustion and hormones affecting the driver's concentration, the steering wheel that is close to the belly, the airbag that could impact the belly and the seat belt that could squeeze the pregnancy to engage the hip bones. Sometimes pregnant women find the seat belt so uncomfortable they choose not to wear it at all.

According to former Director of the Office of Crashworthiness at National Highway Traffic Safety Administration Jim Hofferberth, it was known 50 years ago that seat belts were not an optimal design for keeping pregnant women and their babies safe. The design worked for most of the rest of the population and at that time pregnant women just weren't in the car that much. However, the annual miles driven by women of reproductive age increased 275% from 1969 to 1990. This represents a major increase in fetal exposure to crash risks over 30 years and has likely increased more since then.

Although pregnant women's exposure to motor vehicle crashes has increased, the public health message has lagged behind. Professor Hank Weiss, of the University of Otago in New Zealand, who has been studying the dangers of driving while pregnant for more than 20 years, doesn't anticipate that we'll be seeing warning labels about pregnant driving in cars anytime soon.

"It's more effective if it comes from a health care provider," Weiss said in one report. "It should involve clinicians and direct counseling. It should be on the list of things that women are told to think about."

But it's often not. Obstetricians have a lot to cover during a pregnancy and often they have been told seat belts are effective at protecting pregnant women, if the women follow NHTSA's recommendations for seat belt positioning during pregnancy. And it is effective--using a seat belt during pregnancy is three times safer than not using one. But accounting for all the pregnancies still being lost, just using the seat belt is not effective enough and when the seat belt is so uncomfortable across the low belly that pregnant women don't even wear it, it's not effective at all.

There must be a better way

Staying home is not an option so here are some tips to keep you and your little one safer in the car during pregnancy:
" Gauge how you feel. If you are feeling fatigued, nauseated or otherwise out of sorts, eat a snack, drink some water or take a rest. Wait to drive until you feel you can have more focus.
" Be a passenger. When possible, don't drive, especially as your pregnancy progresses and your uterus gets closer and closer to the steering wheel.
" If you are driving:
" Cut down on distractions. Put your phone away and be extra cautious in traffic or inclement weather.
" Position yourself far back from the steering wheel. Move your seat as far back as is comfortable. Try to position yourself so that your breastbone is at least 10 inches from the steering wheel.
" Tilt the steering wheel toward your breastbone rather than toward your abdomen.
" Remove extra layers. Coats and jackets could interfere with the placement of the seat belt.
" Buckle up correctly. NHTSA recommends that pregnant women wear their safety belt with the lap portion placed under the abdomen and across the upper thighs, as low as possible on the hips and the shoulder strap runs across your chest.
" If you use a seat belt positioning device make sure it has been well designed and crash tested. There is one device called the Tummy Shield that is highly engineered and crash tested which redirects the lap portion of the seat belt away from the abdomen and to the legs, much like a race car driver's seat belt. Crash testing shows the Tummy Shield restrains the woman at least as well as just the seat belt while protecting the abdomen from possible injury from the seat belt going across the belly.