Tuesday, October 05, 2010

The WSJ: "For good luck, More Indians Opt for C-Sections".

"When the Stars Align, Indians Say, It's a Good Time to Have a C-Section" is the title of a WSJ article by Eric Bellman, with contributions from Arlene Chang.

Really? For a minute I had to glance up to see if I was reading WSJ or the Toilet paper Of India. I thought WSJ was a fairly respectable paper, no?

The reason it took me by surprise is because from my limited knowledge and interaction with moms and to-be-moms in India, I found that most of them do not want a C-sec, and that idea also partly stems from an "old-fashioned" way of thinking- that a normal delivery is a good thing and a C-sec is not. Someone I know had a C-sec and her mom related the news to me almost woefully, even though the baby and mom were fine. There is also some kind of notion that going through the pains of childbirth- particularly labour pains- is apparently fulfilling in some way and necessary.

I also know a lot of cases both in India and the US where the C-sec is the decision of the doctor. This could be due to a host of reasons: A genuine medical reason or A litigation-inspired fear that makes the doc want to cover his/her ass and carry out a C-sec or sometimes, its just a question of practicality for the doctor, his/her calendar, or no time to deal with prolonged labour. Most of the times, I know the mothers to be very keen on natural birth, but eventually give in to the doctor.

Then this from the article:

Indians have been asking astrologers for the perfect time to conceive for centuries. Now, with rising incomes and improved access to health care, many take their gurus' advice to their gynecologists to decide birth times as well.

"In the last three years, it has become rampant. Almost everyone prefers to choose timing," says Rishma Dhillon Pai, a Mumbai-based gynecologist. "It's strange, because you would think that as we grow more modern, this kind of thing would happen less."

While there are no data on how often C-section timings are decided by astrology, the number of caesarean deliveries has surged in India. In the early 1990s, around 5% of births in urban hospitals were caesarean. Today more than 20% are, doctors say, in part because of higher incomes and wider access to health care. (Bold emphasis mine)

In the U.S., the frequency of caesarean sections has risen to more than 30% of births, from around 21% in 1998. The rise has been driven by increases in the number of middle-age mothers and overweight mothers, according to doctors, as well as malpractice concerns.

While the vast majority of Indians still prefer natural birth, doctors say the number of caesarean sections where cosmic timing is a factor has jumped from perhaps one-in-10 a decade ago to as many as one-in-two today. Usually, the timing is chosen only after a C-section has been deemed necessary. But doctors say a growing number of women are opting for the procedure when there is no medical need.


Then the article goes on to describe Indians' faith in astrology, how time of birth is so significant, how in two or three anecdotal cases doctors actually gave in to performing C-secs to suit the mother's superstitious beliefs.

Now I do not expect peer-reviewed-quality in-depth reports replete with error bars and statistical significance from a newspaper, but perhaps the author should have mentioned just how many gynecs he interviewed before he wrote this story. After all, in the absence of any other data, that would've been informative.

To me it seems like the article is conflating all kinds of issues: I am not arguing the bit about how the "time of birth" is deemed important in astrology and how people make kinds of decisions based upon it, but it seems a bit far-fetched to claim that is the reason for increased C-secs in India. If the number of increased C-secs in the US can be explained by more practical reasons ["increases in the number of middle-age mothers and overweight mothers, according to doctors, as well as malpractice concerns"], I don't see why all of those can't apply to India, with the odd section of people who actually want to time their baby's birth so that it aligns with the stars. But of course, its more fun and eye-catching to cater to baseless stereotypes, no?

ETA: see this

6 comments:

Anushka said...

I am an Indian and I think the article is just pointing to the increasing trend of women having their babies according to an auspicious time. I have many doctor friends and I know that this is true at least in urban areas.

Nowhere in the article it says that the increase in C-section births are solely or mainly because of mothers-to-be wanting to have their child at an auspicious time.

It also mentions: "While the vast majority of Indians still prefer natural birth, doctors say the number of caesarean sections where cosmic timing is a factor has jumped from perhaps one-in-10 a decade ago to as many as one-in-two today. Usually, the timing is chosen only after a C-section has been deemed necessary."

So the article does mention that the vast majority prefers to have natural births and it also mentions that the auspicious timing is usually chosen only after a C-section has been deemed necessary.

I think your concerns about the article "conflating all kinds of issues" is terribly misplaced.

So stop taking offense when you don't know better.

Deeps said...

I agree with what you have to say about the generalization in the article. But as for getting a C-section done based on good birth time, I personally know 2 families who have opted for it. I find it scary that despite being literate, and well aware of the dangers of a c-sec to a normal delivery, there are people willing to put it all to risk, because of some crazy beliefs!

The_Girl_From_Ipanema said...

Anushka,
I'm not offended. Just surprised.

"So the article does mention that the vast majority prefers to have natural births and it also mentions that the auspicious timing is usually chosen only after a C-section has been deemed necessary."

So then what is the point of this article? That a handful of people are using superstition to schedule their baby's birth, as against "vast majority" ? The heading of the article and all the description about superstitious beliefs and practices in India surely does not set the same tempo. That is what I find conflating. How many doctors did the author interview? You many know ten people and Deeps may know another 2 people, but to me, that is just a small section of stupid people. This article is grossly generalizing and painting with a wide brush, in spite of the disclaimer portion that you have quoted.

Deeps,
That is really stupid. And what is worse is doctors are agreeing. Sad all around. But do you know if those two people were picking C-secs over natural birth, or, having established that they needed C-secs, trying to time it? Either way I agree it is stupid.

gargimehra said...

Hi, just came here from Sayesha's blog.

The question you asked, do you know if those two people were picking C-secs over natural birth, or, having established that they needed C-secs, trying to time it?
I've heard of many instances both ways. Nowadays women who have C-sections almost always seem to consult astrologers for an auspicious date and time.

Others opt for C-sections anyway because of the pain problem perhaps. I've heard too many examples of this from my immediate circle of family and friends in the recent past to ignore the general direction of this article.

The families I'm talking about are urban, well-qualified and some are even doctors themselves. I don't like this idea myself, and am unpleasantly surprised that it has gained such popularity.

Sorry for the long comment. Just thought I'd chime in with my 2 Rs worth.

Deeps said...

I am not sure, but I think one of them picked C-sec over a natural birth and the other one needed a c-sec, so timed it. As you say, either ways it is stupid.

On a parallel note, I'm sure you are aware of this, in US there is this other "natural birth" supporting families who refuse medication even in life-and-death situations. The baby has to born natural, no epidural, no nothing. Sure there are doctors who take advantage and prescribe unwanted stuff, but I feel that any situation where people go against the medical opinion is totally stupid!

The_Girl_From_Ipanema said...

gargi,
thanks for chiming in. So clearly this is happening more frequently..I had no clue- and it is a very disturbing phenomenon.

Deeps,
Yeah- what can I say? I have heard of those crazy people that want to make it a natural birth no matter what and I don't quite get them either.