Initially we didn't understand the complexities of how a pregnancy might affect a trip to a place like India. We thought - OK - we can all go, and we'll all plan to come back the first week of December, when I would be about 33 weeks or so. (Now I'm forgetting all the timeslines.) Indeed, doctors at first didn't even blink - my OB/GYN said that the only thing she'd think about was an early delivery - the NICU would likely not be as sophisticated as one here and if a baby came significantly early, this would be an issue. My regular internal med. doc, at a regular check up when I only suspected I was pregnant, said travel shouldn't be an issue as long as I was in my second trimester (which I am). Then, through a series of other appointments, other medical professionals brought up concerns about malaria. For pregnant women, malaria poses a significant risk to the life of the baby and to the mother. Rajasthan, although not a high-risk area for malaria, has malaria (I think it's some type of medium-risk area, or some technical term that means "medium.")
Too much detail here for our friends .... but we have since had at least three appointments with really well-informed doctors in Boston who have all advised us on the details if we decide to take this measured risk to travel to India while I am pregnant. I will have to take anti-malarials which, although not FDA approved for pregnant women, appear to be safe after the first trimester. I will get vaccines for polio, hepatitis A and typhoid which also - when given as "killed" vaccines - are also supposedly safe. The doctors agree that if we take really specific precautions, in addition to taking medicine - using DEET, sleeping in bednets, not going out at dusk - the risk of getting malaria is really low. (And yes, if you are wondering if I am freaked about about potentially taking these medications during pregnancy even with the blessings of some very conservative and well-informed doctors, you are right.)
We have learned waaaaaaay too much about these things over the past month. Our initial comforting thought - "millions (a BILLION!) of babies are born in India and they're fine" - has been since blown away as a comforting thought. Because I was born in North America and grew up without malaria, I have built up no immuiity to it, and am more susceptible than I or others who live in malarial regions. Apparently, if I get it, it will likely be worse for me because I grew up here (and then worse, of course, because my immune system is compromised by my pregnancy.) I had malaria when I was in Liberia in high school - it's not fun, and I can see why it would be a worry to have it while pregnant. Hence, the concern.
After all this stewing and going back and forth and trying to figure out what's important, Kevin and I feel that my going would be OK, and our doctors back us up on this. (And we live in Boston - where we were able to see an OB/GYN who works at Mass General who specializes in pregnancy and infectious disease and is currently doing a study of malaria in India! All in one person! We have met some pretty great people through this process, and our kids' pediatrician - who is also an infectious disease specialist - has been awesome.) One of the doctors we saw (the OB/GYN who studies malaria) had herself just returned the week before from a trip to Malawi, where she had taken the same malaria meds that I would - and she is 25 weeks pregnant. A good commercial. But because we have been having a hard time figuring out what the mosquito situation really is in Ajmer - our city - we finally decided it makes the most sense for Kevin to get over there and help us figure it out from our actual apartment. (Besides - if we go over in later September, the temperatures may have dropped from the crazy highs of 115 etc that they have now to more acceptable - for me, hot-weather-hater - numbers.)
That's enough from me, but that's what is going on. I promise not to write in this much detail often, but we have been so out of touch with so many people this summer that you now have the full update.
