As my pregnancy more visibly progresses, the question I'm asked most
frequently by relatives and total strangers is not whether I'm having a
girl or a boy, but whether I'm having a C-section. Vaginal childbirth is
very out these days in Tehran. The procedure is quickly edging out the
nose job as the dominant medical trend among Iranians, a people very
fond of surgery. No longer the provenance of last-minute complications
or doctors' liability fears, Caesarean delivery is viewed here as the
modern woman's choice. An Iranian politician I interviewed recently
even worked the normalcy of a C-section into a metaphor describing
Iran's nuclear ambitions. "Nuclear capacity is like a knife," he told
me. "It can be used in a standard operation, say a C-section for you. Or
it can be used to kill someone."
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The subject arose again two nights ago, when a relative visiting from the
provincial town of Maragheh (385 miles northwest of Tehran) praised me
for planning a vaginal delivery. "Most women these days just aren't
willing," he said wistfully. Usually, I'm reluctant to admit my
decision, as people tend to exclaim "how interesting!" with faux cheer
for my medieval birthing plans. My friends cannot resist trying to
convince me to get sliced open. They cheerfully tug up their shirts, and
flash me their discreet little scars, always pointing out how they fall
under the bikini line.
The mounting cache of Caesareans is a natural outgrowth of the
surgery-obsessed culture that has emerged here since the Islamic
Revolution. Forced to cover their bodies in Islamic dress, women focused
on beautifying what remained visible: their faces. That turned Iran into the
nose job capital of the world, and shaped a generation receptive to
elective surgery, in particular procedures that broke with tradition: be
it the classically hooked Iranian nose, or the female ritual of
childbirth. Once having one's nose carved became as routine as a dental
cleaning, Iranians simply grew to feel at home with non-medical surgery.
The appeal is also encouraged by the fact that elective C-sections are
widely available and affordable here, at a time when most people here believe
only celebrities have access to them in the West. Give how little there
is in the world uniquely available to both the average Iranian woman and
Angelina Jolie, you can imagine the draw. "All women in the West would
have Caesareans if they could," a friend informed me recently. "It's
just that insurance companies won't cover them." Everyone here seems to
think this, and it makes women who don't face an overabundance of choice
in their lives feel, in just this one instance, privileged.
Since C-sections cost only a fraction (about $200) more than vaginal
deliveries, their popularity extends throughout middle-class Iran.
I've eavesdropped extensively in the waiting rooms of five separate
obstetricians and can report that traditional, chador-clad women are just
as likely to choose C-sections as their Westernized, pink-veil-wearing
counterparts. Alarmed by the rising rate, the government has started
radio and television campaigns informing women of the risks Caesareans
carry for both infant and mother.
The demand for C-sections is so widespread that it has actually altered
the obstetrician landscape, making it a challenge to find a doctor who
will deliver you naturally. Caesareans are quicker than drawn-out
vaginal delivery, and many doctors find it profitable to perform them
exclusively, fitting in several per day. If a friend recommends a
doctor, you must first ask if he or she is "C-section only." To be taken
on as a vaginal delivery patient, you either have to adjust your
standards (elderly doctors are more receptive to the idea, but they're
out of date with everything else) or audition. It took me four tries
before I found my present doctor, a brilliant, European-trained woman
who has never once promoted a C-section, and doesn't laugh at me when I
ask questions like, "Will I need to wear a veil during labor?" (The
answer is no, by the way, but that's because men, including one's
husband, are banned from delivery rooms).