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We refer to the article on horoscopic births ( , March 3). The Department of Obstetrics and Gynaecology at the Singapore General Hospital does not routinely accede to requests for horoscopic births for several reasons. Astrological signs have no scientific basis or evidence supporting their influence on childbirth outcomes, and promoting horoscopic births can perpetuate misinformation which may confuse or mislead expectant parents. There is, however, good evidence to support vaccination in pregnancy and staying in good health by avoiding smoking, alcohol or drug use. Healthcare professionals are obligated to uphold professional standards and integrity by providing care based on scientific evidence and best practices. Resources such as staff time, equipment and facilities should be allocated to evidence-based practices that improve maternal and neonatal outcomes. Therefore, hospitals should prioritise patient education on evidence-based childbirth practices, prenatal care and postnatal support to let expectant parents make informed decisions. While horoscopic birth practices lack scientific validity, if an expectant mother wishes to incorporate astrological beliefs into her birthing experience without compromising safety, this should be approached in a way that prioritises evidence-based medical care. Obstetricians should establish clear boundaries regarding the extent to which horoscopic beliefs can influence medical decisions. Expectant parents must understand the importance of evidence-based medical care and be counselled about the potential risks of deviating from established practices. While promoting evidence-based care, we respect the autonomy of expectant parents and their desire to incorporate cultural or personal beliefs into their birthing experience. We consult expectant parents to offer guidance, address concerns and ensure that decisions are made that consider medical safety. If a planned caesarean section is the only mode of birth, we have obliged requests for timings that do not compromise safety. Adopting a collaborative and patient-centred approach, we can acknowledge and respect the cultural or personal beliefs of expectant parents while prioritising safety and evidence-based medical care during childbirth. It is essential to strike a balance that honours patient autonomy while upholding professional standards and ensuring the best possible outcomes for both mother and baby. (Adjunct Associate Professor) On behalf of Department of Obstetrics and Gynaecology Singapore General Hospital