When I first became pregnant, I imagined a low-risk pregnancy followed by what many call a “natural” birth. I was ready to learn every labor position, breathing exercise, and pain-management technique for a smooth vaginal delivery.

But pregnancy has a way of humbling you — quickly.

Being over 40 and developing gestational diabetes (GDM) completely reframed my understanding of birth options and the risks involved. Suddenly my dreamy vision of an unmedicated vaginal birth had to make room for conversations about inductions, large-for-gestational-age babies, and, yes — C-sections.

And while I’m still hoping for a vaginal birth, I’m also very clear about one thing:
The second a C-section becomes the safest option, I’m on that operating table.

Facing the possibility of a C-Section

I’ll be honest: the idea of laboring for hours — only to end up in an emergency C-section — terrifies me. Factor in a baby measuring in the 97th percentile and the increased risks associated with gestational diabetes, and the stakes feel high.

My fear isn’t irrational. It’s grounded in data, maternal health outcomes, and what I’ve learned about how quickly labor can go from routine to urgent. My priority, always, is the safety of my baby and myself.

A game-changing MAVEN Clinic conversation

Before my first full meeting with my OBGYN care team, I booked a virtual appointment with an OBGYN through my MAVEN Clinic app — something I now consider one of the best decisions of this pregnancy.

She didn’t tell me what type of birth to choose. She didn’t give me fear-based scenarios.
Instead, she gave me questions — questions that shifted me from passive patient to active advocate:

• What is the C-section rate at the hospital for mothers over 40?
• How common are emergency C-sections for women with gestational diabetes?
• What criteria does your team use to determine when induction becomes necessary?
• How does baby’s growth percentile shape your risk profile?

These weren’t questions I ever would have thought to ask on my own. But as soon as she said them, something clicked. I realized I had been preparing for labor — but not preparing for decision-making during labor.

What I learned (and what the data says)

• The risk of having a C-section increases with age. In one large study of pregnancies complicated by diabetes, maternal age was independently associated with higher odds of cesarean delivery: for every additional year of age, the risk increased by approximately 3.6%. SpringerLink+1
• GDM and related complications like fetal macrosomia or large-for-gestational-age (LGA) babies are strongly linked to higher rates of cesarean delivery. Lippincott Journals+2SpringerLink+2
• For pregnant women with GDM, rates of emergency C-section are higher compared to those without GDM. In one study, nulliparous women with GDM had a significantly greater risk (adjusted odds ratio ~1.9) of emergency C-section than healthy pregnant women. PubMed
• However, induction of labor (IOL) in women with mild GDM — if done before 40 weeks — doesn’t necessarily increase cesarean delivery rates compared with spontaneous labor at term (in controlled studies). PubMed+1
• That said, maternal age (especially over 35–40) combined with induction or prolonged pregnancy beyond 40 weeks does increase likelihood of C-section. PubMed+1

What these data points reaffirm for me is this: yes — a vaginal birth remains possible, even with GDM. But the risks and modifiers (age, baby size, maternal glucose control) make clear why a transparent, medically-informed birth plan is essential.

Learning to advocate for myself

What this journey has taught me is simple — but profound:

There is no “right” way to give birth.
There is only the safest way for you and your baby.

Pregnancy — especially high-risk pregnancy — requires active, ongoing conversation with your care team. It demands learning to ask the right questions, even when you don’t yet know what they should be.

As a first-time woman-over-40 single mom by choice, I’m learning that advocating for myself isn’t just important for my birth plan — it’s essential for the motherhood I’m stepping into.

Questions to Ask Your OB: A Birth Advocacy Checklist

Choosing between a vaginal birth, induction, or C-section isn’t simple — especially when navigating pregnancy over 40 with gestational diabetes. These questions can help you have clearer, more empowered conversations with your care team.

1. Questions About C-Section Rates & Hospital Practices

• What is the C-section rate at this hospital for patients over 40?
• What is the emergency C-section rate for women with gestational diabetes?
• What are the most common reasons your team moves from induction to C-section?
• If I need a C-section, who makes that final call and how quickly does the team mobilize?

2. Questions About Induction (IOL)

• At what gestational week do you typically recommend induction for patients with well-controlled GDM?
• How do you determine whether my baby’s size (97th percentile) affects the timing or method of induction?
• What induction methods do you use first (e.g., Foley balloon, misoprostol, Pitocin), and how do you decide?
• How long do you allow labor to progress before recommending a C-section?

3. Questions About Baby’s Size & Monitoring

• How accurate are growth scans at this stage, and what is the margin of error in estimating fetal weight?
• If my baby continues to measure large-for-gestational-age, how does that change my birth options?
• Do you monitor shoulder dystocia risk and how do you manage it during labor?

4. Questions About Safety During Labor

• What are the early signs that a vaginal birth may no longer be safe for me or my baby?
• How do you monitor glucose levels during labor, and what thresholds change the care plan?
• What’s your protocol for managing prolonged labor in patients with GDM?

5. Questions to Clarify My Birth Preferences

• I prefer a vaginal birth if medically safe — can we outline what “medically safe” means in my case?
• If I opt for induction, can we create a clear step-by-step plan ahead of time?
• What scenarios should I mentally prepare for where a planned C-section becomes the better option?