Iran's Caesarean Section Craze

Azadeh Moaveni | September 21, 2006

http://www.time.com/time/world/printout/0,8816,1537543,00.html


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).






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