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“The major role that motor vehicle injuries have on reported traumatic fetal injury deaths was shown and a significant new challenge for child passenger safety advocates is indicated.”
Professor Hank Weiss concludes in his 2001 study about pregnancy, car crashes and fetal deaths.
Wow! But that was way back in 2001. More than twenty years went by. Surely something has improved or more people are talking about it, spreading more awareness. Surely the National Highway Traffic Safety Administration is creating standards for safety during pregnancy.
Have you heard more about protecting expecting mothers and their babies in the car? No?
Neither have I. All I see is other experts saying things like, “the seat belt is safe and effective,” “just wear it low and you’ll be fine,” and “don’t use aftermarket products, they’re all unsafe.” Sounds to me like, “look away, there’s nothing to see here.”
Diving deep into the research is revealing
About 11 years ago, after we were introduced to the Tummy Shield, we went in search of studies about driving during pregnancy. Are the safety features of the car adequate for pregnant women? Are pregnant women more prone to injury in a crash? Is there anything they can do to increase their odds in a crash?
With his background as a firefighter/paramedic, Greg knew pregnant women are more prone to injury. The department rule was to always bring a pregnant women who was in a crash to the hospital, no matter how serious the crash. He was really excited about the life saving, injury preventing potential of the Tummy Shield.
And for me, after anguishing about the seat belt during three pregnancies, it just made sense. You know, comfort wise. And safety wise. After all, holding the seat belt just a bit away from my bump so it didn’t antagonize my bladder was not technically using the seat belt “correctly.” A lot of pregnant women won’t wear their seat belt because they find it so uncomfortable.
And after reading the studies about driving and pregnancy, we knew we had to add Tummy Shield to our collection of innovative products. Because of what the research revealed, we include pregnancy as an additional stage in child passenger safety. We call it the “plus” stage of the 4 stages of car seats. Seems like maybe Hank Weiss would agree.
Weiss is one of the researchers whose work we reviewed. He was a professor at the University of Otago in New Zealand and studied the risks posed to pregnant women and fetuses by crashes for more than 20 years.
What made Weiss say driving during pregnancy is a new challenge for child passenger safety advocates? Isn’t driving while pregnant just like driving while not pregnant?
Actually, no. Driving while pregnant is different.
Generally speaking women wear their seat belt more regularly than men, but that drops off dramatically during pregnancy (Attico et al 1986).
This is not good since unrestrained women are 2.8 times more likely to lose their baby in a car crash (Hyde et al 2003), especially if they are ejected from the car.
Reasons pregnant women often don’t wear seat belts include:
- seat belt was uncomfortable,
- shoulder strap too tight across breasts,
- lap belt tended to slide up over abdomen,
- lap belt too tight or short,
- fear the fetus would be harmed (Cesario 2007).
An estimated 3,000 otherwise healthy unborn babies are lost every year (about 8 a day) as a result of car crashes (based on ranges in Klinich et al 1999 and Pearlman 1997). And that estimate only counts pregnancies lost that were more than 20 weeks gestation!
“The magnitude of the problem is likely far greater than the numbers show,” Weiss told a reporter for the Atlantic City Lab in 2013, “because many cases — especially those involving early pregnancy — are not recorded in a way that is accessible to researchers.”
A 2015 study shows fetuses are at 5 times the risk of dying in a car crash compared to the first 9 months of a baby’s life. But this statistic is based only on crashes in which both mother and baby died. It does not include the number of crashes in which mom survives but baby dies. (Evans, Redelmeier 2015)
Even if they do wear a seat belt.
No one leaves the house thinking they’ll be in a crash that day. Yet it happens. Every. Day.
Pregnant women are just as susceptible as any other person. A University of Michigan study showed 170,000 crashes a year involve a pregnant woman. Of those 116,000 report some sort of injury.
In the first trimester, the uterus is still low in the abdomen and surrounded by the pelvis. It is relatively well protected.
However, in the second and third trimesters, it grows upward and outward, losing the protection of the pelvic ring and displacing other abdominal organs. Researchers Greg Friese and Randal Wojciehoski add, at this point — around 12 weeks — the uterus is now more susceptible to injury.
Their 2005 study estimated that 1,500 to 5,000 fetal deaths each year result from maternal involvement in motor vehicle crashes. And those statistics do not include uncounted adverse outcomes from motor vehicle collisions, like possible life-long disabilities from injuries or complications from an emergency delivery.
Download our free PDF guide: Safer Driving During Pregnancy
Common fatal outcome
Placental abruption is most frequent cause of fetal death after car crash. Cases of abruption within five days of crash have been reported. Sometimes a loss can even be a couple weeks after a crash. And often doctors never connect the two.
Placental abruption occurs in 1 to 5% of crashes considered of minor severity during pregnancy and from 20 to 50% of severe crashes during pregnancy. Some placental abruptions may result from high-velocity, low-mass airbag loading, or from compression between the mother’s body and the steering wheel, seat belt, or instrument panel. (Klinich et al, 1998)
“While these results show that placental injuries can occur to properly belted pregnant occupants, they also show that avoiding belt use during pregnancy may significantly increase the risk of placental abruption and subsequent fetal loss in a crash,” Klinich’s study said. So definitely wear a seat belt!
Common injury
Head trauma is the most common direct fetal injury, especially in later terms of pregnancy when the head is positioned low. Friese and Wojciehoski believe head trauma results from the baby being compressed between the maternal pelvic bones and the seat belt, steering wheel or dash.
We have years under our belts as child passenger safety technicians, and Greg has years of experience as a paramedic. We know the seat belt is the first line of defense. It is designed to hold the occupant in place in their seat so they do not move forward enough to hit the steering wheel or dash.
In Taylor’s experience when she lost her baby to direct head trauma during her 8th month of pregnancy, she was sitting in the passenger side properly wearing her seat belt as low as possible on her hips. There was no steering wheel, obviously, and she did not come in contact with the dash. As a matter of fact, the only visible injury she had was a bruise on her low abdomen where she was correctly wearing her seat belt.
The crash picture above is Taylor’s car. It was a fairly moderate crash at low speeds. She contacted us while she was still in the hospital and researching if there was anything that could have prevented her loss.
What do studies suggest?
Many of the studies recommend health care providers counsel pregnant women more about the risks of driving during pregnancy. They need to emphasize the importance of wearing their seat belt. On average, only 48.7% of care providers reported counseling for seat belt use during prenatal visits. And of those only 27% of the women remembered the counseling. (Weiss et al, 2007)
Getting all healthcare providers sharing information in a more memorable way is a first step. We suggest the information come from multiple sources like pregnancy books, magazines, and — as Weiss suggests — child passenger safety technicians.
But we recommend experts informing pregnant women of not only how to — and how important it is to — “properly wear” their seat belt while pregnant but also the potential risks so they can make a fully informed decision.
Pregnant women should:
- always wear a seat belt correctly — low and snug over the hips; (We believe the crash-tested Tummy Shield offers optimum protection by safely redirecting the seat belt away from the belly, creating a leg harness like a race car driver. And we agree, not all pregnancy seat belt postioners are created equal — most are untested and unsafe.)
- keep airbags activated and make sure to direct it toward the chest area instead of straight out at your bump;
- avoid driving at night or in bad weather, when the risk of a crash is highest;
- drive on roads with lower speeds, because low-speed crashes are exponentially less traumatic than high-speed crashes;
- simply try to drive and ride in cars less, have others run errands or take public transportation, if possible.
(Go here for more tips for safer driving during pregnancy.)
Women go to great lengths in order to reduce risk to their developing children in other ways. Would it really be such a stretch to add precautions for safer driving during pregnancy?
For more stats, stories and suggestions, read all of our blogs about driving during pregnancy.
We want to know, during your pregnancy did your doctor counsel you about driving and wearing your seat belt? Share your comments below.
By Amie Durocher, Creative Director at Safe Ride 4 Kids and certified CPS Tech since 2004
Copyright 2024 Safe Ride 4 Kids. All rights reserved. You may not publish, broadcast, rewrite or redistribute this material without permission. You are welcome to link to Safe Ride 4 Kids or share on social media.
We originally published this post in September 2016. We updated the article for accuracy and comprehensiveness.
Sources in order of mention:
- Attico NB, Smith RJ 3rd, FitzPatrick MB, Keneally M., “Automobile Safety Restraints for Pregnant Women and Children.” The Journal of Reproductive Medicine. March 31, 1986 (3):p187-92.
- Hyde, Lisa K.; Cook, Lawrence J. MStat; Olson, Lenora M. MA; Weiss, Harold B. MPH, PhD; Dean, J. Michael MD, MBA; “Effect of Motor Vehicle Crashes on Adverse Fetal Outcomes.” Obstetrics & Gynecology. Volume 102, Issue 2 (August 2003): p279-286.
- Cesario RNC, PhD, Sandra K., “Seat Belt Use in Pregnancy: History, Misconceptions and the Need for Education.” Nursing for Women’s Health. Volume 11, Issue 5 (October|November 2007): p474–481.
- Klinich KD, Schneider LW, Eby B, Rupp J, Pearlman MD. Seated anthropometry during pregnancy; 1999a. UMTRI-99-16
- Pearlman, M.D., “Motor Vehicle Crashes, Pregnancy Loss and Preterm Labor.” International Journal of Gynecology and Obstetrics.Volume 57, Issue 2 (May 1997): p127–132.
- Evans L, Redelmeier DA. “Traffic Deaths Before and After Birth.” European Journal of Obstetrics & Gynecology and Reproductive Biology volume 194, (November 2015): p258-259.
- Friese, Greg; Wojciehoski, Randal F.; “Fetal Trauma from Motor Vehicle Collisions.” EMS World. (July 1, 2005)
- Klinich, Kathleen DeSantis; Schneider, Lawrence W.; Moore, Jamie L.; Pearlman, M.D.; “Injuries to Pregnant Occupants in Automotive Crashes.” University of Michigan – United States Paper Number 98-SP-P-17 (1998).
- Weiss, HB; Sirin, Hulya; Sauber-Schatz, Erin K.; Dunning, Kari; “Seat Belt use, Counseling and Motor-Vehicle Injury During Pregnancy: Results from a Multi-State Population-Based Survey.” Maternal and Child Health Journal. Volume 11 (2007): p505-510.
