In India, C-sections are in the stars

NEW DELHI, India — It's the night before the Hindu festival Dussehra and Dr. Rishma Dhillon Pai is preparing for a long day come morning. One patient has already scheduled a cesarean section for the auspicious occasion, and another just checked in for the same, even though the hospital is officially closed for the holiday.

Dr. Pai, who is a consultant gynecologist at the Jaslok and Lilavati hospitals in Mumbai, and the first Vice President (Elect) of the Federation of Obstetricians & Gynaecologists of India, says the requests for elective C-sections shoot up during the festival seasons or on "auspicious" dates, such as the recent 09/09/09.

"Muhurat C-sections," as they're quickly becoming known ("muhurat" in Hindi means an auspicious time period), are part of a wider trend across Asia, in which tens of thousands of women are opting for surgical cesarean sections in the hopes of having babies on a date and time deemed lucky by their astrologers. Middle and upper class Indians, with access to some of the best health care in the world, are now increasingly opting for this highly controversial practice.

"A patient told me that if her child was delivered on the time dictated by her astrologer, it would be a boy, his skin would be fair and he would look after his parents in their old age," says Dr. Pai. She says people can be very finicky about having doctors deliver at exactly the right time. "If they say that the baby should come out at 11:15 a.m., you're literally making the incision and waiting for three minutes until it's 11:15 to get the baby out."

"Historically, it was the conception time that was important, but now people are asking about birth times as well," says astrologer Ajai Bhambi. He advises women and their families on auspicious times and dates depending on the position of the moon, on one condition: the woman's doctor must already have determined that there is no other safe option but to have a C-section.

In a survey conducted by Delhi's leading private hospitals, led by Sitaram Bhartia hospital, in 2007, it was revealed that the cesarean section rate is almost as high as 65 percent in some of these facilities. It is up from 40 percent in 1997, despite a World Health Organization directive that such deliveries should not exceed 15 percent of any society.

However, the numbers, while indicative of a trend, don't tell the entire story. In India, most deliveries take place in neighborhood nursing homes, whereas the more complicated cases are referred to private hospitals. These high-risk deliveries are more likely to be performed through cesarean sections and hence skew the percentages.

Smita Choudhuri, a 34-year-old management consultant from New Delhi, who had a planned cesarean section after her doctor said she had no other option, said she found it helpful to consult Bhambi on the birth date of her baby.

"In our culture, we believe in astrology, and as long as it's in our benefit, there shouldn't be a problem," says Choudhuri. She has been visiting Bhambi for almost a decade and credits him for various improvements in her life.

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