Gestational diabetes, the risk of uterine rupture due to a previous caesarean scar, a large baby causing obstructed labour, and the potential for postpartum haemorrhage combined to make Ms N’s pregnancy particularly high-risk at the age of 40. Despite these challenges, she delivered safely through vaginal birth thanks to the close monitoring and coordinated care of FV’s experienced medical team, who are highly skilled in managing complex cases.

Living With the Anxiety of Gestational Diabetes

When Ms N, living in Ho Chi Minh City, learned she was pregnant at the age of 40, she felt “a mix of joy and worry”. Aware of the increased risks associated with pregnancy after 35, she chose to place her trust in the doctors at FV Hospital to guide her through this challenging journey. It was also the place where she safely delivered her first two children.

In her previous pregnancies, Ms N had given birth to large babies – a known risk factor for gestational diabetes and for having another large baby in subsequent pregnancies. This concern was confirmed when test results showed she had developed gestational diabetes.

Gestational diabetes increases the mother’s risk of pre-eclampsia, premature birth, caesarean delivery, infection, and later developing type 2 diabetes. It can also affect the baby, leading to excessive growth, hypoglycaemia, or respiratory problems.

On examining Ms N, Vo Thi Thanh Van, MD, MSc, from FV Thomson Maternity, explained: “Being older, with a previous caesarean scar, a history of gestational diabetes, and now carrying a large baby with excess amniotic fluid, this patient faces a high risk of uterine rupture, gestational diabetes complications, and blood clots leading to embolism. These are common risks in older mothers.”

To provide the best care, Dr Van collaborated closely with other FV specialists to develop a personalised plan for Ms N. In addition to close monitoring throughout her pregnancy, she followed a tailored diet developed by Dr Nguyen Viet Quynh Thu, Head of Dietetics and Nutrition at FV Hospital, which limited sugar and starch. This was combined with 30 minutes of daily exercise. FV’s doctors also encouraged her to remain calm and positive, as stress could raise blood sugar levels.

Creating a Personalised Natural Birth Plan for a High-Risk Pregnancy

During her antenatal visits, Ms N expressed her wish to have a natural delivery for her third child. Dr Van supported her decision, while carefully noting the associated risks: uterine rupture from the previous caesarean scar, shoulder dystocia due to the baby’s large size, umbilical cord prolapse caused by excessive amniotic fluid, and postpartum haemorrhage from uterine atony – one of the most serious emergencies in obstetrics.

To ensure the safest possible birth, Dr Van created a detailed plan: managing the baby’s weight to reduce the risk of shoulder dystocia; closely monitoring for signs of uterine rupture; guiding Ms N through effective pushing techniques; carefully regulating contractions with oxytocin to support a vaginal delivery; and monitoring her closely after birth to prevent postpartum haemorrhage.

At the end of July 2025, Ms N went into labour. Thanks to the carefully planned birth strategy, everything progressed smoothly. In the delivery room, with her husband by her side and FV’s experienced team fully prepared for every scenario, she safely welcomed her third child.

Overwhelmed with joy, Ms N shared: “Meeting Dr Van truly felt like fate. She was so dedicated and attentive, guiding me carefully from the very start until the end of my pregnancy.”

For Ms N, FV has always been a place that brings absolute peace of mind during childbirth. “My husband and I considered many options, but ultimately chose FV for its safety and the feeling of giving birth as if on a retreat. Nurses are available around the clock, doctors explain every detail thoroughly, and everyone, from security staff to cleaners and service teams, is caring and cheerful.”

What Should Older Expectant Mothers Do to Ensure a Safe and Healthy Pregnancy?

According to Dr Van, Ms N’s smooth delivery was made possible by closely monitoring three key factors during labour: the baby, the mother’s pelvis, and uterine contractions.

“The baby’s weight was kept within a safe range, the pelvis was wide enough for a vaginal delivery, and labour progressed naturally with the support of oxytocin to regulate contractions. This meant the mother did not need to push excessively, reducing the risk of uterine rupture. In addition, the thickness of the uterine wall at the previous scar site was assessed in advance and found strong enough for a safe vaginal birth,” the doctor explained.

Pregnancy after the age of 35 carries higher risks such as gestational diabetes, pre-eclampsia, hypertension, miscarriage and placental complications. The likelihood of congenital abnormalities in the baby, such as Down syndrome, also increases significantly.

However, older women can still enjoy a healthy pregnancy by following careful antenatal care: attending regular check-ups, completing recommended tests, taking vitamins, maintaining a balanced diet, exercising, and avoiding unhealthy habits. It is also important for expectant mothers to be monitored at medical facilities equipped with advanced technology and staffed by experienced specialists in high-risk pregnancies, ensuring coordinated multidisciplinary care to protect the health of both mother and baby.

Dr Van also advises women over 35 to check for ectopic pregnancy early on, as the risk is higher in this age group. Close follow-up is essential to detect and manage risk factors such as pre-eclampsia, diabetes and foetal abnormalities.

“Older expectant mothers can still have a healthy pregnancy if they receive proper care and close monitoring,” Dr Van emphasised.

Dr Vo Thi Thanh Van graduated from Pham Ngoc Thach University of Medicine in 2016, completed her Master’s degree in Obstetrics and Gynaecology at the University of Medicine and Pharmacy, Ho Chi Minh City, in 2020, and received further training at Antoine Béclère Hospital, France, a leading centre for high-risk pregnancy care and foetal intervention.

For more information about maternity services at FV Thomson Maternity, FV Hospital, please contact (028) 35 11 33 33 or visit us at 06 Nguyen Luong Bang Street, Tan My Ward (former District 7), Ho Chi Minh City.