The Safest Way to Drive While Pregnant

Standard seat belts aren't designed for pregnancy but are still the best option. Here, CR's advice on the right way to wear a seat belt when you're expecting.

Pregnant woman in drivers seat wearing seatbelt
The correct way to buckle up when pregnant.
Photo: Anatoliy Shumskiy/Consumer Reports

It was a route Taylor and Ryan Olsen had driven countless times. They were rounding the bend on a backroad headed to Taylor’s mom’s house in Northern California, carrying precious cargo: the couple’s first child, a girl, who was due to be born in just five weeks. But on this day, in October 2015, a driver in another car blew past his stop sign and hit the front passenger side of the Olsens’ vehicle, near where Taylor was sitting.

Taylor was wearing her seat belt, with the lap portion correctly positioned below her sizable pregnant belly. While the belt prevented her from being flung into the dashboard—she sustained only minor injuries—she was rushed to a hospital because the baby’s heart rate had dangerously slowed. Doctors performed an emergency C-section, and determined that the baby’s skull was fractured by the force of the impact of her body against the seat belt itself. 

“She lived for about 12 hours,” says Taylor of her daughter, named Bailey. “She passed away from the skull fracture.”

Devastated, Taylor wondered why her seat belt hadn’t better protected her baby—and why that risk wasn’t on her radar. “I didn’t think about it because it’s not something that’s talked about all the time. I mean, people drive every day pregnant,” she says.

More On Safe Driving

It’s clear from crash-test studies that it’s crucial at all times to wear a standard three-point seat belt, which includes the lap and shoulder belt, because it significantly reduces the risk of injury in many car crashes. "Buckling up prevents ejection and being thrown against the hard surfaces of the vehicle interior,” says Emily Thomas, PhD, automotive safety engineer at Consumer Reports. "And that’s true whether you are pregnant or not."

But it is also true that pregnant people and their fetuses have unique vulnerabilities in car crashes. And, for the most part, seat belts are not designed with those vulnerabilities in mind.

Vehicles and restraint systems are tailored to protect average-sized males, says Stefan Duma, PhD, a professor of engineering at Virginia Tech in Blacksburg, Va., and one of the few people who has studied car crashes involving pregnant people. “Everything is optimized for them. That’s bad for small women, for the elderly, and for kids,” he says. And, he adds, it’s bad for pregnant people.

To address that risk, some companies sell products known as seat belt adjusters or positioners—devices that attach to the lap portion of a seat belt and essentially anchor it down between the user’s legs, further away from the abdomen. The sellers of these products claim that the devices divert the force from a crash impact away from the pregnant belly and onto the upper thighs, among other places.

But do these adjusters work, or does using them create a different kind of risk of its own?

Given the high stakes, and how much research goes into car safety, you might think the answer would be clear. But unfortunately, as with so much else about driving while pregnant, the answer is murky.

A Hidden Problem

What we do know is that the way hospitals and the National Highway Traffic Safety Administration keep records doesn’t fully capture how many fetuses are killed or injured in car crashes each year. 

“There are many reasons pregnancy-related crash statistics are vastly underreported or unaccounted for,” says Hank Weiss, PhD, adjunct associate professor of population health sciences at the University of Wisconsin School of Medicine and Public Health, who has published much in this area.

For example, records of fetal deaths are stored separately from regular death certificates. And NHTSA and the Centers for Disease Control and Prevention only pull regular death certificates when reporting on transport-related incident data. So fetal deaths are not well documented in motor vehicle crash reports. Further, fetal death records are typically not generated if the pregnancy is under 20 weeks.

Also, if the pregnant driver or passenger dies from a crash but there is no delivery or autopsy, the fetal death or its cause may not be reported or even ascertained.

Even when there is a record of a fetal death or injury from the mother’s trauma, it is not classified in hospital or vital statistics data systems with a specific cause. “It basically just says ‘death or injury to the fetus due to maternal injury,’” Weiss says. “They fall through the cracks in numerous ways and this leads to little ongoing reporting of the problem.”

In the absence of firm records, experts instead can only estimate the number of fetal deaths, based largely on annual population pregnancy rates and numbers of car crashes. By extrapolating, the research suggests that car crashes in the U.S. are the leading cause of fetal injury, and that each year some 160 pregnant women are killed in motor-vehicle crashes, and 800 to 3,200 fetuses die when the mother survives. 

In addition, Duma estimates that car crashes are responsible for more fetal losses per year than for deaths of children ages zero to 4 who are strapped into car seats. “And yet look at how much we talk about car seats,” he says.

Fetuses are particularly at risk during car crashes in numerous ways: A fetus can be injured from direct force during a crash, as happened to Olsen when she was pregnant. But the most documented cause of harm to the pregnancy in a crash is placental abruption, which is when the placenta detaches from the uterus, depriving the fetus of oxygen. Other pregnancy-related problems include a ruptured uterus, a drop in fetal heart rate, and early delivery. Of course, if the mother dies in a crash, that can lead to the death of the fetus as well.

Perhaps not surprisingly, the higher the speed of the crash, the greater the potential for injury. One study led by Duma involving computer-simulated crashes of cars with pregnant occupants found that the risk of fetal injury was 33.5 percent at speeds of 15 miles per hour and 61 percent at 25 mph.

Despite this high risk, there has been little innovation from car manufacturers aimed at improving seat belts for pregnant people.  

General Motors, Ford, Toyota, and Volvo have funded some research in this area or invested in computer models that assess risk to pregnant occupants in crash tests, but there are only a handful of crash-test dummies that simulate a pregnant person. And those models are rudimentary, says Kathleen D. Klinich, PhD, associate research scientist at the University of Michigan Transportation Research Institute, who helped to develop and crash-test one of the first pregnant dummies.

What scientists have found, however, is that the three-point seat belt offers better protection for pregnant people than no seat belt at all. Research led by Klinich, published in the early 2000s (and partially funded by NHTSA and GM), was the first to show that the risk of adverse outcomes for fetuses is reduced when the mother is wearing a seat belt in a car crash.

But does the seat belt as presently designed mitigate that risk enough for pregnant people and their unborn babies? Could more be done? After a flurry of research from the late 1990s to about 2011, there have not been many studies published on this issue, in large part because funding for research that might improve car restraint systems for pregnant people hasn’t been a priority.

What About Seat Belt Adjusters?

Perhaps given automakers’ lack of attention to pregnant car occupants, several companies have developed aftermarket seat belt attachments for pregnant people to use in their cars.

However, the government does not set standards for these devices or regulate them. As a result, none have been adequately crash-tested. That hasn’t stopped some companies, though, from making claims about their seat-belt adjusters for pregnant women

For example, the maker of the MimiBelt, a seat belt adjuster that is meant to redirect the lap belt so it stays between the user’s thighs, say on its website that it has “NHTSA & ANCAP vehicle safety approval.” This implies that both the U.S.’s NHTSA and the Australasian New Car Assessment Program, which works in Australia and New Zealand, have endorsed the product. A MimiBelt spokesperson did not answer CR’s questions about the claims.

But both the U.S. and Australian entities told CR that is not accurate. 

A spokesperson for NHTSA said the agency “does not have a safety standard that directly applies to belt positioning devices,” and added that aftermarket seat belt adjusters “do not fall under regulations, since they are neither installed as part of a completed vehicle nor as part of a seat belt assembly.”

Similarly, a spokesperson for the ANCAP said it “does not set requirements for, or assess, aftermarket products or vehicle modifications,” and that seat belt adjusters have “not been tested or endorsed by ANCAP, and any claims by the manufacturer in relation to ANCAP endorsement are incorrect.”

Another seat belt adjuster for pregnant people is called the Tummy Shield, which is sold by Colorado-based Safe Ride 4 Kids. The company does not claim that its product—a stainless steel plate and anchor that hooks the lap belt into a V-shape between the user’s legs—is approved by any government agency. 

But the company does say that its own testing found that the Tummy Shield withstood the impact of a simulated crash. 

Independent experts acknowledge that more needs to be done to protect pregnant women and fetuses in car crashes, and say that seat-belt adjusters might eventually play a role. For example, Duma, at Virginia Tech, says the devices might "be helpful especially because some women will tend to let the lap belt ride up a little too high...and if that gets too high, you put the load through the pregnant uterus, and that’s obviously not ideal." He notes that seat belt adjusters might also serve to remind women to properly position their seat belts under their bellies. 

Still, researchers also say that at this point there are too many unknowns about the aftermarket seat belt adjusters.

“There are some circumstances where [the devices] could be helpful, but there are other instances where they could be misused or cause slack in the belt or cause redirected loading” of the forces of impact, says Klinich, at the University of Michigan.

Lotta Jakobsson, a senior technical specialist at the Volvo Car Safety Center adds that “nobody has found a better solution” than the three-point seat belt, and messing up the parts of the seat belt can be problematic.”

Thomas, at CR, agrees. “A non-regulated, aftermarket belt positioner could introduce slack into the seat belt system, increasing injury risk in a crash," she says.

What You Can Do

Though the three-point seat belt is not expressly designed for pregnant people, and the lap belt may press sharply against the pelvis in a crash, experts highly recommend that pregnant women wear a seat belt at all times in a car. The American College of Obstetricians and Gynecologists states that “you and your fetus are much more likely to survive a car crash if you are buckled in.”

But it’s critical that you wear the seat belt correctly. To do so, follow these instructions:

Adjust the Seat

You should be in a comfortable, upright position with as much distance as possible between your belly and the steering wheel or dashboard.

Pregnant woman adjusting drivers seat

Photo: Anatoliy Shumskiy/Consumer Reports Photo: Anatoliy Shumskiy/Consumer Reports

Adjust the Steering Wheel

If driving, be sure you can comfortably reach the steering wheel and pedals.

Pregnant woman adjusting steering wheel

Photo: Anatoliy Shumskiy/Consumer Reports Photo: Anatoliy Shumskiy/Consumer Reports

Put the Seat Belt on Properly

Pull the shoulder belt across your chest (between your breasts) and away from your neck, not off your shoulder or behind it. Then position the lap belt underneath your belly.

Pregnant woman in drivers seat wearing seatbelt

Photo: Anatoliy Shumskiy/Consumer Reports Photo: Anatoliy Shumskiy/Consumer Reports

Adjust the Location of the Shoulder Strap

To reduce slack in the seat belt and ensure it lies flat against your chest, you may need to raise or lower the position of the shoulder belt.

Person adjusting seatbelt strap lever

Photo: Anatoliy Shumskiy/Consumer Reports Photo: Anatoliy Shumskiy/Consumer Reports

Position the Lap Belt Under Your Belly

The lap belt should fit snugly across your hips and pelvic bone—underneath your belly. That way, in the event of a crash, the strong bones in your hips and pelvis may partially absorb the impact of the crash.

Green checkmark symbol on top of photo of pregnant woman wearing seal belt correctly positioned

Photo: Anatoliy Shumskiy/Consumer Reports Photo: Anatoliy Shumskiy/Consumer Reports

Don't Wear the Lap Belt Over Your Belly

That could harm your fetus in a crash.

Red "x" over photo showing wrong way to wear seatbelt while pregnant

Photo: Anatoliy Shumskiy/Consumer Reports Photo: Anatoliy Shumskiy/Consumer Reports

Note: Never disable the airbag. It is designed to work with the seat belt and can help prevent your head from crashing into the dashboard.

Also keep in mind that if you don’t have to drive, it’s best to sit in the front passenger seat, and to push the seat as far back from the dashboard as possible. The back seat does not have the benefit of an airbag in most cars.


Rachel Rabkin Peachman

I'm a science journalist turned investigative reporter on CR's Special Projects team. My job is to shed light on issues affecting people's health, safety, and well-being. I've dug deep into problems such as dangerous doctors, deadly children's products, and contamination in our food supply. Got a tip? Follow me on Twitter (@RachelPeachman).