Honeymoon in Tehran: Two Years of Love and Danger in Iran (34 page)

“The c-section is actually an Iranian procedure, referred to in the
Shahnameh
as
‘Rostamzad,’
” she said. The
Shahnameh’s
hero, Rostam, is born by cesarean. The labor of his mother, Rudabeh, the wife of the warrior Zal, has stalled because of Rostam’s extraordinary size. Fearing that his wife will perish, Zal summons the Simorgh, a mythical bird embodying the purity and wisdom of the ages, who performs a cesarean section, or rather a
Rostamzad.

“I think you’re just pain averse,” I told her. “And, if you don’t mind my saying so, anxious to retain vaginal tone.”

“Tone!” she gasped. “Azadeh!”

The subject had arisen two nights ago, when a relative visiting from the provincial town of Maragheh praised me for planning a natural delivery. Apparently vaginal labor had fallen out of favor even in that remote quarter of the country. “Good for you. Most women these days just aren’t willing,” he said wistfully. I enjoyed the encouragement, but felt rather discomfited by having this conversation with so many people. Though they were squeamish about our having lived together before marriage, even distant relatives demanded to know in the first minutes of a conversation whether I would be delivering the baby from between my legs.

The cachet of cesareans was a natural outgrowth of the surgery-obsessed culture that had emerged since the 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 made a generation receptive to elective surgery, particularly procedures that broke with tradition, be it the classically hooked Iranian nose or vaginal childbirth. Once having one’s nose carved became as routine as a dental cleaning, Iranians grew more comfortable with other unnecessary types of surgery.

The appeal of c-sections was enhanced by the fact that they were widely available and affordable, and many Iranians wrongly believed only celebrities had access to them in the West. Given how little there was in the world uniquely available to both the average Iranian woman and Angelina Jolie, you could imagine the draw. “All women in the West would have cesareans if they could,” a friend informed me. “It’s just that insurance companies won’t cover them.” Nearly everyone seemed to believe this, and it made women who didn’t face an overabundance of choice in their lives feel, in just this one instance, privileged. Many of the country’s doctors were the first in their families to join this large and growing professional class, and they encouraged the surgery with particular zeal. Not only was it lucrative, but it also made them feel more modern as well, practicing cesareans rather than presiding over vaginal delivery, which humans had managed to do even when they lived in caves.

Since c-sections cost only a fraction more, about $200, than vaginal deliveries, their popularity extended throughout the middle class. Most Iranians received health care through their employers, and insurance plans accommodated their choice of delivery. Judging from the conversations I had eavesdropped on in the waiting rooms of my prospective obstetricians, traditional, chador-clad women were at least as likely, if not more so, as their westernized counterparts to choose c-sections. They were often heavier and unfit—a function of the richer foods they ate, the long hours they spent indoors, and the lingering traditional preference for the plump female figure—and doctors told them their bodies were too out of shape to deliver naturally. A handful of doctors sought to counter the c-section trend by popularizing the use of epidurals, which were neither well-known nor widely available in Iran. But rather than educating women about pain relief choices, they marketed what they termed “painless labor” as though it were a type of spa experience. Naturally, most women found the idea of painless vaginal labor altogether suspicious, and the epidural failed to catch on. Alarmed by the rising rate of cesareans, the government launched radio and television campaigns informing women of the risks the surgery carried for both infant and mother. But as far as I could see, so far women were not listening. They were easily duped by unethical doctors who told them they were too overweight/out of shape/angular/melancholy for a conventional birth.

The demand for c-sections was so widespread that it had actually altered the obstetrician landscape, making it a challenge to find a doctor willing to deliver naturally. Cesareans were quicker than vaginal delivery, and many doctors found it profitable to perform them exclusively, fitting in several per day. My friend’s obstetrician unabashedly told her: “If I deliver you by c-section, we can plan the procedure in advance. I can show up freshly showered, my tie knotted properly, relaxed. Wouldn’t you prefer that?” When my friends recommended a doctor, I had to first ask if he or she was “c-section only.” That’s why the stern, elderly female doctor came so enthusiastically recommended. She frowned on the c-section craze and would never have interrupted a vaginal delivery, to falsely advise the parents that the
baby’s heartbeat had slowed and that a cesarean was necessary. Arash, who worried that a doctor reluctant to facilitate vaginal birth would sabotage our choice during labor, promoted her as our choice.

We met the second candidate when we sought out a clinic that specialized in advanced, three-dimensional ultrasounds. She seemed a bit skittish as she guided the probe around my stomach, and began most of her sentences with the unreassuring phrase “Well, the textbook says …” Fresh out of residency, she was up on all the latest prenatal tests (half of which were not available in Iran, anyway), but she didn’t inspire my confidence. She was also expensive. She charged the equivalent of $35 for an ultrasound, in a city where the usual rate was $7.

An elder, respected relative, himself a doctor, recommended a colleague who had been practicing for four decades at a prominent Teh ran hospital. Half of the city, it seemed, wanted to be delivered by him, and his waiting room was packed with women in black chador. He barely spoke, and when words did emerge, they were few and barely audible. He clearly belonged to the women-have-been-birthing-in-Iran-for-centuries school of ob-gyns, and did not consider newfangled notions like prenatal testing, heartrate monitors, and omega-3 supplements relevant to the age-old process of popping out a baby. As I ran down my list of questions, he and his midwife-assistant exchanged smiling glances, not bothering to conceal their amusement. Clearly they thought I was a neurotic, westernized Iranian who was taking childbirth far too seriously. They also immediately dismissed my request that Arash be permitted in the delivery room.

That Iranian hospitals prohibited men from being present as their wives gave birth was the only thing that had given me pause when we discussed whether to have the baby in Iran. The country’s medical services were usually decent, in certain fields superb. A generation of doctors had trained during the bloody eight-year war with Iraq, quickly acquiring experience that surgeons in peaceful societies would gain only in a lifetime. Iranian medicine suffered from the limited availability of drugs for complicated cancer and HIV regimens and of instruments used for recently developed procedures. When our friend Neda’s uncle, for example, was diagnosed with prostate cancer, she
spent two full days a week tracking down and waiting in line for his chemotherapy medication. But for more commonplace matters—childbirth, cosmetic surgery, a fractured knee—Iran was one of the best places you could hope to find yourself.

Many affluent Iranians chose to go abroad for their deliveries, but this seemed to involve much expense and inconvenience for the sake of being able to remark “My Amir-Ali was born in Paris.” I discovered the no-husbands policy only incidentally, when my friend Nazila recommended her doctor, adding at the end of her glowing endorsement, “And she even lets your husband stay in the room!”

“What do you mean, ‘lets’? Where else would he be?” I had several pregnancy guides, and they all devoted at least three pages to the tasks delegated to the husband during delivery: the wiping of the brow, the proffering of snacks, the administration of massage, the cutting of the umbilical cord, not to mention the coaching in Lamaze breathing.

The policy, like so many of the regime’s, lacked any agreed-upon or express rationale. Nazila suggested it was because some hospital delivery rooms included more than one bed, and it would be considered inappropriate for men to be among bareheaded, splay-legged women who were not their wives. The midwife of the reticent doctor offered another explanation.

“Men in Iran don’t attend pregnancy and labor classes like men in the West,” she said. “They aren’t prepared for the visceral reality of childbirth, and they are liable to lose control. They might suddenly become furious with the doctor for touching their wife’s private parts. Or they might somehow think the doctor is hurting her. If they freak out, they could compromise the labor.”

It was as though she were describing a race of Neanderthals who communicated with grunts and clubs, rather than Iranian men in the twenty-first century.

“Lots of men in the West don’t take any special classes,” I said, unconvinced. “And they seem to do just fine.”

“Then there is the situation our country is in,” she said. As in Iraq, the word “situation” was colloquial shorthand for the complicated,
painful political realities that invaded every aspect of daily life. I was not surprised, particularly, by the no-husbands regulation. It was in keeping with the wide range of human behavior the state’s codes precluded—parties, dating, dancing. But it rankled more than those other restrictions, because it could not be ignored in private. You felt the sting of such limits only as the relevant circumstances arose and you realized yet one more thing you had never expected to be a problem was banned. The no-husbands rule was on par with the laws that meant a mother could never take her son swimming once he reached a certain age. I discovered this when a friend of mine, the divorced mother of a ten-year-old, called one day to ask whether Arash would take her son swimming. Pools and beaches are both separated by sex, and my friend’s ex-husband was never around to take the boy. Witnessing the miracle of a child’s birth, swimming together as a family—these were probably not basic human rights, I supposed. But they were small, modest joys that infused life with meaning.

I
was lying on an examination table when the midwife entered, complaining about the husband of a patient in the next room. “What century are we living in? Who does this man think he is! Not even a doctor. Telling his wife an annual pap smear is ‘unnecessary’ Silly man. I’ll tell him what is unnecessary.” The midwife, flushed and indignant, straightened her navy smock, and flounced back into the other room to challenge the unfortunate man who had deemed the routine monitoring of his wife’s cervix superfluous.

Finally, I had found the perfect doctor. Dr. Laleh Amini: under forty, French-trained, confident, and attentive. The impeccably chic boots and shifts she wore under her white coat, I realize, should not have made a difference to me, but they added to my impression that we inhabited the same world—one in which husbands were meant to be in the delivery room (“Of
course
we’ll smuggle him in, don’t worry for a second”) and expectant mothers’ questions were answered respectfully. It was a well-known fact that Dr. Laleh was married to a prominent juice tycoon, which meant she worked out of passion for
her job and would not market c-sections to maximize her profits. She cautioned her patients to resist the traditional Iranian ministrations to the pregnant woman: “They will try to turn you into a veal. They will keep you inside and make you eat twice or three times as much as you really need. Don’t listen.”

Given her European qualifications, Dr. Laleh could easily have charged exorbitant fees and catered to exclusively wealthy Iranians. But she asked no more than the most ordinary Tehran doctor. As a result her waiting room overflowed most days with everyone from Afghan immigrants to diplomatic wives. Other doctors constantly rang her cell phone for advice, and most of her responses involved her saying, “Well, the proper treatment for X disease is Y therapy or Z machine, but since we don’t have either in Iran …”

Unlike the reticent doctor, she was hypervigilant, ordering a battery of blood tests that had the local laboratory blinking in confusion, and she checked her pregnant patients monthly for bladder infections. Her indignant midwife, a French-speaking Zoroastrian, shared her blunt way of handling men who accompanied their wives and interfered in their medical treatment. Neither of them wore a veil in the office, even when husbands were present. A brass
fravahar,
the age-old symbol of Zoroastrianism, hung near pictures of Dr. Laleh’s children in the treatment room. I loved the bustle and cleanliness of the office, and most of all Dr. Laleh’s uncompromising way of pushing everyone—the laboratories, the hospital maternity unit, the local pharmacies—to pay attention to detail, to aim higher. In this, of course, she was working against the current of the Islamic Republic, which permitted a culture of sloth and laxness in such places. People like her tended to burn out midcareer, exhausted from constantly taking on a culture that dwarfed their solitary purpose. But for now, she was here, zealous and chic, and I was thrilled to have found her.

One afternoon she told us we were having a boy, showing us his cycling legs and arms bobbing up and down on the ultrasound screen. Arash beamed with delight and pointed out how active he was, claiming this heralded a mischievous and jaunty personality. On our way out of the office, he paused by the elevator and asked me, “Do you
realize the baby boy inside you will be considered legally more valuable than you?” I ran a hand over my bump, and pondered this in a whole new way.

Iroubled by an encounter earlier that day at the gym, I absentmindedly stirred too much salt into the curry I was making for the evening’s dinner party. I had arrived wearing one of the standard uniforms of young women in the capital: a veil, a manteau, and jeans. As the receptionist handed me a locker key, she told me they had been visited earlier by the local authorities, who warned that unless their patrons started dressing more conservatively, the gym would be shut down during its morning hours, those reserved for women. She tugged uncomfortably at a strand of hair as she relayed the message. It had been a long, long while since the government had launched a widespread crackdown on what women wore. This new approach, which was coupled with raids on clothing shops that sold “immodest” manteaus, signaled a canny shift in tactics. Rather than provoke young people’s ire by harassing them on the street or in parks, the regime would recruit civilian intermediaries, so that people could police one another. That way, the hapless messenger would be the immediate target of resentment, rather than the state. Was it coincidence that the authorities had chosen gyms as the first locations to police? If women did not comply, was their freedom to exercise at risk?