Iran's Caesarean Section Craze

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."

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).