Dana Hudepohl

Although Feeney is determined to go through with her decision, she’s learned to keep her plans to herself. Her husband and doctor are supportive, but other people tell her she’s “copping out.” “You’d think it was the worst thing in the world to do,” she says. Some other expectant mothers she’s met online are horrified and have accused her of being ignorant and selfish. One woman even told her that she’s going to be a terrible mother because she’s only thinking of herself rather than doing what’s best for her baby. “I thoroughly researched all the possible complications of C-section versus vaginal delivery and there are possible complications with both,” she says. “Believe me, if I had found any statistical evidence that a C-section was worse for my baby, I would not do it.”

Feeney is just one of a growing number of women across the country who are asking their doctors to deliver their babies by C-section even when they have no medical indication not to have a vaginal delivery. A study released last week by HealthGrades, a Denver company that studies healthcare quality, found that approximately 88,000 women had elective C-sections in 2002, up from about 71,000 in 2000, an increase of nearly 25 percent. “I think it would be safe to say that this is probably an under-representation of what’s actually going on,” says Dr. Samantha Collier, vice president of medical affairs at HealthGrades, noting that doctors may not always specify in the paperwork when a C-section is truly elective. “I don’t know that it’s ever going to completely replace vaginal delivery but I think it will continue to be a growing trend.”

For decades, not having unnecessary C-sections was the feminist cause célèbre; can it be that having them — a decision, like abortion, that is increasingly couched as a woman’s “choice” — is the new feminist cause?

“What the women’s movement did was push for women to be able to choose a less medicalized birth, with less risk of having an intervention imposed on them that they didn’t need,” says Amy Alena, program director of the National Women’s Health Network, a group that opposes C-sections except when they are medically necessary. “And that’s the real problem with the movement for the C-section option: If it’s presented to a woman as, Here are two equal options, it’s no surprise that women are going to choose it. But if it’s presented in what we would be considered a more balanced way, we think fewer women would be likely to choose it, because there are greater risks [with a C-section].”

According to the latest data from the Centers for Disease Control and Prevention, the rate of C-section is at an all-time high, with more than one out of four American women giving birth by surgery. While the bulk of this number is still made up of C-sections that are performed for medical reasons — like a baby in breech position or with a dropping heart rate — more and more women are requesting surgery. Their reasons run the gamut: Everything from the convenience of scheduling a birth to fearing labor, hoping to avoid a marathon delivery with complications or wanting to prevent long-term bladder, bowel or sexual problems that sometimes result from vaginal delivery.

But the optional C-section trend is making some doctors fume. “The outrageous cesarean rate we now have in this country is a national medical disgrace,” says Theodore M. Peck, M.D., a perinatologist at the Gundersen Lutheran Medical Center in La Crosse, Wis., and author of “Empowered Pregnancy.” “A general principle that we as doctors go by is ‘Above all, do no harm.’ By offering some anxious women the ‘easy way out,’ we are in fact potentially doing harm to some of them.”

The debate over elective cesareans started publicly in the spring of 2000 when then-president of the American College of Obstetricians and Gynecologists (ACOG), Dr. W. Benson Harer Jr., argued for “maternal-choice cesarean” in an editorial printed in the association’s journal. Doctors were forced to pick a side as more patients entered their offices with requests. From 1999 through 2002, the number of elective C-sections provided to women with no previous C-section rose almost 42 percent, accounting for more than 2 percent of more than 4 million deliveries. If more women start getting their way, that number could skyrocket. In an online survey at Newshe.com, a Web site put out by sexual health experts Drs. Laura and Jennifer Berman, when nearly 2,500 women were asked, “Would you opt for a C-section over a vaginal delivery if you had the choice?” 37 percent answered “Yes”; another 9 percent answered “Not sure.”

With the recent surge in prenatal yoga classes, midwives and doulas, it may seem strange that some women are opting to medicalize their births. But if a woman can decide what kind of birth control she should use, whether to get an abortion and if she wants an epidural to ease labor pains, why shouldn’t she have a say in how she delivers her baby, ask some doctors and women. Proponents point to evidence showing that when healthy women choose to have C-sections, the risks, benefits and costs are balanced between C-sections and vaginal delivery. They conclude that the choice should be the mother’s. Critics — doctors, midwives and women among them — answer back that a C-section is major surgery with risk of complications, longer recovery and potential problems with future deliveries.

If it seems like a medical community divided, it is. It hasn’t helped that ACOG, which represents more than 45,000 physicians, left the issue open to debate when, last October, its ethics committee issued an official opinion on elective C-sections. After more than a year of deliberation, the group concluded that it is ethical to provide an elective C-section if the doctor believes it is in the best interest of the woman and her fetus and if he has advised her of the risks involved. If the doctor believes a C-section would be detrimental to the health and welfare of the woman and her fetus, he is ethically obliged to refrain from performing the surgery. If the patient and doctor cannot agree on a method of delivery, he should refer the woman to another doctor. The ACOG cautioned that evidence to support the benefit of elective cesarean is still incomplete and that there are not yet extensive morbidity and mortality data to compare elective cesarean delivery with vaginal birth in healthy women. In other words, the jury is still out.

Without conclusive evidence, where does this leave women who decide they want a C-section? They have little idea of how their wishes will be received by their physicians. Stories are sprinkled throughout Internet pregnancy message boards of women who have learned that they have a right to choose, but when they ask their doctors for C-sections, they are denied. It’s no wonder: A recent Gallup survey of 301 female OB/GYNs showed that even women who take care of other women are sharply split. Thirty-six percent said they would not perform a C-section if a woman asked for it, 32 percent said they would, and 28 percent said it would depend on the woman’s circumstances.

“I had to actually leave my OB in my last trimester to find someone who would do [the surgery], says “Millie,” a contributor to the pregnancytoday.com message boards. “The entire practice I was in — all 8 doctors — refused to do an elective c/s for me and I would have been forced into a vaginal delivery if I had stayed there. It really does suck to be faced with no choice in how you give birth.”

Risks of C-section surgery include excessive blood loss, infection, anesthesia complications, bowel blockages, and uterine adhesions that could lead to dangers in future deliveries. “C-sections are incredibly safe, but bad things can happen during medical procedures,” says Dr. Jerome Yankowitz, director of the division of maternal and fetal medicine at University of Iowa College of Medicine, who is against elective C-sections unless a patient has been thoroughly counseled. “It can be unnecessary surgery analogous to liposuction. Most people have no complications, but then there are a few who do. Afterwards people think, ‘Why did they do that? They weren’t that heavy!’” Yankowitz says he knows of many cases of bladder damage in the mother, bad wound infections and bowel injury as a result of C-sections. Many doctors advise against elective C-section if a woman plans on having more than two children since subsequent surgeries become riskier. “Our concern is when C-sections are done a second, or third, or fourth time, you’re working on a scarred area,” says Marion McCartney, a certified nurse-midwife and director of professional services at the American College of Nurse-Midwives. Her organization issued a statement last fall against elective C-sections, stating that “purported benefits of cesarean section on demand are unproven and the known risks place the woman’s life and reproductive future on the line.”

Supporters of elective C-section acknowledge that there are risks and that a woman must be fully informed before making a choice, but that doesn’t mean she shouldn’t be able to choose. “There’s less morbidity from C-section than there is from breast implants,” says Brent W. Bost, M.D., a gynecologist in Beaumont, Texas, who has published research on elective C-sections. “We’ll let women have a breast augmentation, plastic surgery and liposuction, which all have risks involved simply to look better; why will we not let them choose cesarean section?” The C-section risk data doesn’t apply to elective C-sections, adds Bost, who performs about two dozen elective C-sections a year, since it comes from lumping together all C-sections. There is a difference between scheduled surgeries performed on healthy moms and those done on moms in less stable condition (for example, who’ve gone through hours of labor first or who have endometritis). “You’ve got to remember that elective C-section is a different animal,” he says. “You have to compare apples to apples.”

The fact that no large-scale studies have been done to compare apples to apples is what concerns nurse-midwife McCartney. “Before physicians jump in and say there are no problems with C-sections, I’d like to see a study comparing a healthy vaginal delivery to a healthy C-section,” she says. “Most people think the study has been done already and it hasn’t. Women think they’re having an opportunity to make a choice, but what they’re really getting is their provider’s opinion.”

Donna McDonald, a 31-year-old obstetrical nurse in Lexington, Mass., says she felt like she had all of the information she needed when she decided to schedule a C-section for her first baby last year. As a nurse, she had seen postpartum women with urinary incontinence, hemorrhoids and protruding uteruses from pushing, rectal tears, and episiotomies that had been sewn too tight. But what influenced her the most was witnessing her sister’s traumatic labor and delivery, which included three hours of pushing and an episiotomy. “After I saw what she went through, I said my experience has to be very different,” she says.

Choosing a C-section gave McDonald, a self-described “control freak,” a sense of, well, control over the delivery. “I was concerned about birth trauma and wanted to avoid forcing my baby out,” she says. “I felt the safest thing for my baby was a C-section where my doctor, who I completely trust, could be in control.” The surgery went smoothly. Even the recovery, which so many people had warned her would be painful, was easier than she expected. “People told me I was crazy — that the recovery was going to be so much harder — that I would be laid up and need help, but I found it the opposite,” she says. “When my husband and I got home I was a little bit sore and I couldn’t do laundry and vacuum — I pretty much stayed on the couch — but I think that every postpartum woman needs relaxation time the first couple of weeks anyway.”

Not all women look back on their scheduled C-sections so fondly. Many women who are forced into a C-section for medical reasons have found the recovery so painful that they question why a woman would choose to have the surgery. Stephanie Higgins, 24, had planned to have a drug-free natural delivery, but when her baby was three weeks late and estimated to be over 11 pounds, her doctor recommended that she schedule a C-section. “I feel like I missed out on an easier, more natural process,” says Higgins, who couldn’t get out of bed or pick up her newborn — who, it turned out, only weighed in at 8 pounds, 15 ounces — for days because of the pain from her cut stomach muscles. More distressing than the soreness was that she had difficulty nursing. “Since my body had not gone through labor, it took longer for my milk to come in,” she says. “My baby was hungry and I had nothing for her for a good five days. It was a really difficult experience.” While Higgins believes that women should have a choice how they deliver, she wishes she had been able to stick to her original birthing plan. “People say, ‘I wouldn’t want to go through the pain of childbirth,’ but there’s a lot of pain with a C-section — and I had an uncomplicated one. The recovery was much more difficult than anyone I knew who had a vaginal delivery.”

Proponents of elective C-section are more interested in talking about the mother’s long-term health than the weeks after the baby is born. “The first few weeks after you have the baby is a lot different than the rest of your life,” says Bost. Studies have associated vaginal delivery with higher risk of lasting consequences, including pelvic organ prolapse and urinary or fecal incontinence. “In a vaginal delivery, you stress the vagina out of proportion and then expect the muscles to come back and respond, but they may not,” says Bost. “Some of us are beginning to suspect that vaginal delivery may also damage the walls of the vagina and decrease vaginal lubrication for intercourse and may also damage the nerves in the vagina that make arousal for women more pleasurable.”

No one is more familiar with these distressing repercussions than the doctors who treat them. Last August, Dr. Kathleen Kobashi, a Seattle urological surgeon, told the Seattle Times that she chose a C-section because she didn’t want to risk the pelvic floor problems that she fixes in other women. UCLA urologist Jennifer Berman wrote a detailed account on her Web site about why she chose a C-section with her second child. After delivering her first child, Max, she completed a reconstructive surgery fellowship and saw women who suffered from incontinence and prolapse — where the uterus can fall through the vaginal opening — as a result of vaginal delivery. “Had I seen patients with such problems before Max was born, I would have elected to have a C-section with him, too,” she writes.

Just because a woman delivers vaginally does not mean she will experience long-term problems. But a new study of 363 women from Tel Aviv University does show that elective C-section can have a protective effect. The prevalence of urinary incontinence one year after women delivered vaginally was 10.3 percent, but for women who had an elective C-section with no labor, it was only 3.4 percent. (It was 12 percent for women who had a C-section after laboring). Dr. Alison Weidner, an OB/GYN at Duke University Medical Center who sees women on a day-to-day basis suffering from childbirth-related pelvic problems, decided she didn’t want to take that risk when her doctor predicted her unborn child would weigh more than 10 pounds. “Twenty percent of women who attempt a vaginal delivery risk ending up with a C-section anyway and a C-section after labor is more risky than doing it before,” she says. “The most common cause of complications following C-section is infection, including infection of the uterus and wound infections, which is highly associated with prolonged labor and prolonged rupture of membranes. By definition, if the section is performed electively, these two situations of prolonged labor and rupture of the amniotic membranes don’t exist, substantially decreasing the likelihood of infection after delivery.” Weidner also points to the fact that it’s estimated that overall morbidity is reduced from 24 percent to less than 5 percent when C-section is performed electively, as opposed to in labor. “This is a very touchy topic,” she admits. “But in my mind, it should be an individualized decision between a patient and a doctor. When you need treatment for, say, prostate cancer, you have options. I don’t understand why delivery of an infant is any different.”

Scheduling birth is a not a uniquely American phenomenon. In Brazil, the overall cesarean delivery rate is 50 to 60 percent and climbs to 90 percent among wealthy women delivering in private hospitals. South Korea has one of the highest C-section rates in the world, with almost half of Korean women delivering by C-section (up from 6 percent in 1985 and 21.3 percent in 1995). In Denmark, nearly 40 percent of OB/GYNs agree with the woman’s right to request a C-section. But recent media coverage of Hollywood’s elective C-section trend with headlines like “Too Posh To Push” (Time) have given the issue a sense of elitism. For example, actress Denise Richards told People magazine in April that she scheduled her delivery around the television taping schedule of her husband, actor Charlie Sheen. Critics are concerned that all of the hype blurs the reality of what women having surgery have to go through. “It’s like any fad out there,” says Meg Ferrante, a natural-childbirth instructor near Atlanta. “It sounds great and easy and fast and painless and some women enter into it excited, like it’s a day at the spa.”

As word spreads and more women jump on the C-section bandwagon, healthcare specialists worry about the consequences. On average, C-sections are twice as expensive as vaginal deliveries. Can maternity wards handle a rising demand for elective C-sections? Yes, says Bost, since those numbers don’t apply to elective C-sections. His research, published in the Journal of Obstetrics and Gynecology, found that when you factor in nursing, medication, and monitoring during long labor, the costs of vaginal deliveries and elective C-sections balance out. He concluded, “Adopting a policy of cesarean on demand should have little impact on the overall cost of patient care.”

Feeney, who is scheduled to become a mom this month, is hoping her personal choice will help pave the way for other women. “I am thrilled at the thought of planning the birth of my baby, of knowing when he’ll come and being totally ready,” she says. “I embrace the medical technology that will turn what could be 20 or 30 hours of excruciating and unpredictable pain into a 30-minute procedure that will birth my baby for me, with some predictable discomfort during recovery. I would not have it any other way.”

Moran first considered getting the procedure, which permanently blocks the tube carrying sperm from the testicles to the penis to prevent pregnancy, when he was 23 and in the Navy. “But none of the doctors would consider it,” he says. “They said I was too young and that I would change my mind.”

He didn’t.

So when things got serious between him and Barros early last year, he decided to take action. They both hated condoms, and Barros had sworn off birth control pills after she experienced bad side effects. “We’re in it for the long haul so it made sense to snip-snippy,” he says. Barros said she was thrilled. “We both wanted peace of mind as soon as possible,” she says.

Moran isn’t typical of the roughly 600,000 men who get vasectomies each year. According to several urologists who spoke with Salon, the usual candidate is married, in his late 30s or early 40s and has two or more children. In fact, a Western Washington University study found that the likelihood of sterilization rises with age, duration of marriage and number of children. While Moran’s choice might be unusual, it’s not unheard of. Although no doctors or data could confirm a growing trend, many of the individuals Salon spoke to who have decided not to have children said the surgery is gaining popularity among their circle of friends.

“I know probably a dozen [men without children who've had vasectomies],” says Laura Keuling, 27, a paralegal from Queens, N.Y., whose fianci got one four years ago. Browse through Internet message boards for the “child-free” (the term preferred by many people who choose not to have children) and you’ll find postings by men in their 20s and 30s like Moran who’ve already gotten vasectomies or who hope to one day. “As scary as getting a vasectomy was for me, it was far scarier sweating every time I had sex and waiting for good news or bad news,” writes “Zaphod,” on NoKiddingBoard.com. “I am not a big fan of Russian roulette. It is the only way for you to have control over your own destiny. Condoms are not foolproof. Sterilization is as close as you are going to get.”

While there are no statistics about this subset of men just yet, there soon will be. For the first time ever, the government’s National Center for Health Statistics (NCHS) has asked men — nearly 5,000 of them — about their family planning and reproductive choices. Among the data expected to be released on Father’s Day: how many men plan on remaining childless for good — and how many of those men have gotten vasectomies to set that decision in stone.

Most likely, the numbers will be far from staggering. What is startling, though, is that this is the first time that the numbers will even exist. Until now, discussions about contraceptive use and desire for children have largely revolved around women. The NCHS has been collecting data on women’s reproductive choices in the National Survey of Family Growth since the 1970s. It’s taken 30 years for them to ask men the same questions. “This is very unique,” says Gladys Martinez, associate director for science at NCHS. “It’s the first time you get the man represented by himself.”

This newfound interest in men’s reproductive choices by the government is only one indication that Americans are no longer ignoring the fact that men want to play an active role when it comes to deciding whether or not to have children. For decades, guys who wanted to take the reins and handle the responsibility of birth control had only two options: condoms and vasectomies. Today, a handful of drug companies are closer than ever to developing hormone-based male contraceptives. “There is a major interest in finding a male contraceptive,” says Henry Gabelnick, director of CONRAD, an organization that is teaming up with the World Health Organization to study injectables for men combined with testosterone. “My guess is it’s going to be four or five years before there is enough data to have a product on the market, if not later. But, ultimately, [the market] will change.” Other forms of male contraceptives that work by interfering with the development of sperm or their functioning will likely take longer to develop. In November, a study in the journal Science made big headlines when it found that male monkeys injected with a protein had an immune reaction (developing high antibody levels and preventing the sperm from fertilizing the egg) and could not impregnate females.

“The fact that men have reproductive opinions is now being acknowledged to a greater extent,” says Patricia Lunneborg, retired professor of psychology at the University of Washington and author of “The Chosen Lives of Childfree Men.” And it’s about time, say some men. “The man’s opinion should carry as much weight as the woman’s,” says Jerry Steinberg, “founding non-father” of No Kidding! an international 10,000-member organization for people without children. “It takes two to make a baby, and it should take two to make the decision.”

What will be the repercussions of a growing public discourse on male reproductive choice? Will it translate into more intentionally childless men in the future? Could it mean more men, like Moran, opting for vasectomies? Perhaps. “There is more information out there so men can make informed decisions,” says the author of “Child-Free Zone,” David Moore, 38, who had a vasectomy in October. “We were already totally committed to being child-free, but a friend visited with their young child and drove my wife and I mental,” he says. “I also thought it would be a good idea to get my wife off the pill.” Keuling’s fianci, Vincent Ciaccio, 27, a health specialist in New York, is one of those men affected by this slowly changing climate. “Until I was 18, I thought if you were biologically able, you had kids,” says Ciaccio, co-leader of his local chapter of No Kidding! “Men need to know that they have the right to not want to be a father, and they have the right to make that choice a permanent one.”

Vasectomies — which cost between $300 and $1,500 and are often covered by insurance — have become routine 10-minute office procedures since a no-scalpel technique was introduced in the United States in the 1980s. The surgery is so routine that, according to recent reports from England, British nurses may soon be allowed to perform them without a doctor present. But just how much choice a young, unmarried or childless — or all of the above — man really has when it comes to accessing a vasectomy is debatable. As Moran found out when he was 23, if you don’t have any children, your request for a vasectomy may not be taken seriously. Three doctors turned down Steinberg before he found one who would sterilize him at 34. It can be so difficult for child-free men to find an agreeable urologist that the message boards on the No Kidding! site include a section where members who’ve been sterilized can provide referral info for willing doctors.

Why do men who don’t want to have children face roadblocks when it comes to choosing to make their choice permanent? “Just like with abortion, sometimes reproductive choices are looked at as being outside the realm of standard medicine,” says Cornell University urologist Peter Schlegel, president of the Society for Male Reproduction and Urology. “Opinions are allowed to run rampant and personal views are applied by practitioners.” It doesn’t help that umbrella organizations like the American Society for Reproductive Medicine and the American Urological Association have no ethical guidelines on vasectomies — such as who should get them and in what scenarios — leaving doctors an open window to make the call.

It’s a common practice, for example, for some doctors to make arbitrary age cutoffs for vasectomies. “If someone were to call me and say, ‘I’m 28, single and I don’t want children,’ I would not waste their time and money to come in and see me,” says Dr. Michael Warren, a urologist at the University of Texas Medical Branch in Galveston. His office only schedules a vasectomy consult if the candidate is over 30 with two kids or under 30 with more than two kids. The reason for his policy, he says, is that in his 33 years of practice he’s seen too many men (whether they have children or not at the time of the surgery) later change their mind. “I have no problem with somebody wanting to live that way, but I know they might not always,” he says.

Dr. Richard Vanlangendonck, a urologist at Ochsner Clinic Foundation in New Orleans, agrees that considering age when clearing a candidate is common sense. “When you’re 22, you don’t know what your life is going to be like three years from now,” he says. “When you’re 35 or 40 you’ll have a better idea.”

But consistent scientific data to back up doctors’ policies is lacking. A Danish study conducted in 1987 found that regret is two to three times more frequent among men sterilized before age 30 than in men sterilized after 30. A more recent study done at the Cleveland Clinic Foundation found that vasectomy reversal occurred 12.5 times more often in men who underwent vasectomy in their 20s than in men who were older. Yet an Australian study found that men who were intentionally childless were not overrepresented among men seeking to surgically reverse their vasectomies. (The urologists that Salon spoke with who specialize in vasectomy reversals confirmed this trend, or lack thereof, in their own practices.) In fact, a study that compared 44 childless men and 51 fathers who got vasectomies at the Planned Parenthood Association of Maryland during a four-year period concluded that vasectomy is physically and psychologically safe for both groups.

Sterilized men who don’t have children face criticism for being selfish, immature and shortsighted. “I’ve had someone tell me that it was wrong of me to make the choice when I was still a kid,” says Ciaccio. “I’ve had people tell me that I’ve robbed my future wife the opportunity to be a mother. I don’t think I can count the number of people who said I’ll change my mind and it’ll be too late.” But here’s the question that young men who have gotten vasectomies are asking: Why is it acceptable to make the permanent choice to have kids at a young age and not OK to make the permanent choice to not have kids? “The truth is, I put more thought and energy into not having kids than many people do into having them,” says Ciaccio. “What’s the worse scenario — a man regretting his vasectomy or a man regretting accidental parenthood?”

There are always exceptions — like the man one urologist recalled, who got a vasectomy after he and a bunch of drunken buddies decided they didn’t want to get their girlfriends pregnant; he later visited the doctor requesting a reversal — but the bulk of the childless men who opt for vasectomies seriously think through the consequences. A Scottish survey of 78 men and women who were voluntarily childless concluded: “The findings of this study suggest that voluntary childlessness is not an expression of neurosis or immaturity; rather, it is a complex decision of which the benefits are considered to outweigh the costs of social nonconformity.”

According to Lunneborg’s research, there are four major reasons men don’t want children: They want the freedom to change jobs without financial obligations to children; they want time and space for personal development; they have never felt a need to have children and are happy as they are; and they don’t want the responsibility of raising a child.

Even so, not all men who don’t want children are interested in vasectomy. They’re either happy with their current method of birth control, don’t like the idea of a doctor messing with their prized parts or aren’t 100 percent sold on the permanence of their feelings. But to a segment of men who’ve determined they don’t ever want children, getting a vasectomy doesn’t feel like an extreme measure. The Australian study found that men who are most likely to seek sterilization are what researchers call “early articulators” — they’ve made the explicit decision at a young age not to have children. They choose surgery because they are unwilling to cope with the anxieties of using contraception that is not permanent.

Before Ciaccio got his vasectomy, he and Keuling were so paranoid that a birth control “oops” would ruin their plans for a child-free future that they simultaneously practiced three forms of birth control — the pill, condoms and withdrawal. Still, any time Keuling’s period showed up a few days late, they were terrified. “Living with the threat of accidental pregnancy is hellish, plain and simple,” says Ciaccio.

Ciaccio didn’t take the decision to get sterilized lightly. As an experiment, every day for one year, he asked himself if he had to make the choice that day, would he have a vasectomy. For 365 days straight, the answer was yes. Many days, he polled Keuling for her feelings, too. Before meeting with surgeons, he created a four-page document that outlined his reasons for wanting a vasectomy, his knowledge of the procedure and potential side effects, such as swelling, bleeding or infection. “I included the answer to any question the doctor could envision throwing at me before it could even escape his lips,” he says. All three doctors that he interviewed were willing to do the surgery. “Doctors are starting to recognize that people have as much of a right to ensure their child-free status as they do to have children.”

Even though it has been four years since Ciaccio had his surgery — and he is still confident that he made the right decision — he continues to hear criticism from some friends and co-workers. “Not a day has passed in the past three years when I haven’t thought about my vasectomy and smiled,” he says. “But I still have people tell me I’m going to regret it later in life. My favorite response to that is to ask if they’re planning on having kids. If the answer is yes, I respond, ‘You’ll change your mind and it’ll be too late!’”

Many of the doctors who spoke with Salon said that although they discourage vasectomies in men in their 20s with no children, if the patient is still adamant after being counseled “six ways and sideways” on the risks of the procedure, they most likely will not turn him away. “I offer a service and I don’t make moral judgments,” says Dr. Brett Mellinger, a urologist in private practice in Long Island, N.Y., who performed Ciaccio’s vasectomy. “The individual has to get the information and make the appropriate decision.”

About 6 percent of men who undergo a vasectomy will eventually request a surgical reversal, most of the time because they want to have children with a new partner. While there are no statistics on how many of those men already have children, Dr. Larry Ross, a urologist at the University of Illinois at Chicago, estimates that only 10 to 15 percent of the patients he sees who come in for a reversal are childless men who have changed their minds. Dr. Arnold Belker, a clinical professor of urology at the University of Louisville School of Medicine who has been practicing for 35 years, does not recall ever doing a microsurgical vasectomy reversal, his specialty, on a childless man. Unlike the 10-minute vasectomy procedure, reversal surgery requires approximately four hours on the operating table, time off work and a $10,000 to $25,000 out-of-pocket investment, since reversals aren’t covered by insurance. “While it’s very easy to do a vasectomy, it is very difficult to undo it,” says Warren.

To weed out the wishy-washy so that this doesn’t happen, doctors try to drive home the permanence of the vasectomy when they counsel interested men. “You can’t do a vasectomy thinking that it can be reversed,” says Dr. Larry Lipshultz, chief of male reproductive medicine and surgery at Baylor College of Medicine in Houston. While the success rates of returning sperm to the ejaculate are pretty good — in the 80 percent range if reversed within the first 10 years — post-reversal pregnancy odds aren’t as high. And the more time that passes from the vasectomy, the lower the chances of a successful reversal. Some men change their minds after learning the stats.

Add one modern twist to the decision-making process: Thanks to the widespread use of reproductive technology, post-vasectomy pregnancy is now possible using in vitro fertilization or intrauterine insemination. Guys can bank their sperm before the procedure (though most don’t) or can get sperm extraction surgery after the fact. Both are expensive. Asks Lipshultz: “How many men want to put out $20,000 for not having to use condoms?”

Not all child-free men who get vasectomies are in a committed relationship at the time. After Steinberg, who was single, had his surgery, courtship took on a different dynamic. “Several women didn’t want to see me after the first date when I told them not only that I didn’t want to have any children, but that I had had a vasectomy,” he says. “That was fine with me because it’s better to nip it in the bud than allow a relationship to build, only to be shattered months or years later when the unsolvable dilemma of whether to have children arose.”

Brian Curtis, 35, a technical writer and editor in Atlanta, also felt the romantic aftershocks following his operation at age 22. He had the operation within six months of starting his first job with medical coverage because he was so spooked by stories of friends who had gotten “oopsed” into unplanned parenthood. At the time, his girlfriend — whom he had already told that he didn’t want kids — was taken aback by the finality of his decision. A few months later, they had an argument where she complained that he had taken the choice away from her. “I disagreed, noting that I was never going to have kids, regardless of the surgery,” he says. “So her choice was the same as it had been before: If you want kids, you’d better start seeing someone else.” She did.

It’s been 13 years and Curtis has no regrets. “It was one of the smartest and most responsible decisions I’ve ever made,” he says. Since then, he’s been upfront with women about his sterile state. For the past two years, he’s been in a relationship with a woman who also does not want children. “We were friends first so I knew about the vasectomy before we got involved,” says his girlfriend, who asked to remain anonymous. “Personally, I think it’s the wisest decision a man can make when in the position of not wanting children. It’s wonderful to be able to play with him and not have to worry one iota about pregnancy or birth control failure.”

Contrary to popular belief, pregnancy is possible following vasectomy. A recent report found that 0.15 percent of women experience an unintended pregnancy within the first year of their partner’s procedure. (Granted, that’s 100 times less than the 15 percent that get pregnant in one year of typical use of the condom.) It takes approximately 20 post-surgery ejaculations before sperm are cleared from the semen so couples temporarily have to use backup contraception. Even after this wait period, pregnancy is possible in rare cases. A recent study published in the journal of the American College of Obstetricians and Gynecologists that looked at 544 women whose husbands underwent vasectomy found that six pregnancies occurred in the weeks or years after surgery. Keuling, Ciaccio’s fiancie, is considering getting sterilized “just as an extra security,” she says.

Moran, who had his vasectomy in May, recently went for a routine follow-up visit where the doctor confirmed that he had a zero sperm count. “It’s a relief,” he says. “Sex with a loved one shouldn’t be ruined by worry.” He and Barros have tossed the condoms and say they’re happier than ever. When they are out together and hear screeching kids, they give each other a knowing look and feel a sense of relief. Still, as the wedding approaches (where no kids are allowed, of course) Moran is all about keeping an open mind. “Even if I somehow changed my mind, there’s always adoption,” he says. “There are plenty of kids just waiting for parents.” That, he believes, is the beauty of reproductive choice.