With the higher price of the private system comes better amenities and shorter wait times, but also all of the trappings of fee-for-service medical care. C-sections can be easily scheduled and quickly executed, so doctors schedule and bill as many as eight procedures a day rather than wait around for one or two natural births to wrap up.

“It’s a money machine,” Borges said.

The economics of private insurance certainly play a role, but culture is also a big part of what drives the C-section epidemic here.

“Childbirth is something that is primitive, ugly, nasty, inconvenient,” Simone Diniz, associate professor in the department of maternal and child health at the University of São Paulo, said. “It takes long, and the idea is we have to make it fast. It’s impolite for doctors to leave cases for the doctors on the next shift. There’s a sense that you need to either accelerate it or do a C-section.”

Even in public hospitals, the C-section rate is roughly half of all births. Because so many patients are booked in advance for C-section procedures, women who want natural births find themselves on zero-hour sojourns to find free beds. One Sao Paulo doctor told me that some physicians ask for bribes in exchange for allowing mothers to deliver naturally. And in an extreme example from earlier this month, a woman named Adelir Carmen Lemos de Goés was forced by police to deliver by C-section in the southern Brazilian state of Rio Grande do Sul.

Poster for the Brazilian C-section protests (Rafael Ricoy)

As a 2005 editorial in the Brazilian Journal of Obstetrics and Gynecology put it, "There is no doubt that, even if it contains unnecessary or even greater risk to the mother or the newborn, ceasarean section has a much lower risk for the obstetrician.”

Granted, many women ask for the procedure of their own accord, seeing the convenience and sterility of it all as a marker of liberation rather than oppression. Rio and Sao Paulo are dotted with upscale C-section resort clinics where women get post-op manicures and room service.

But a 2001 study of Brazilian women published in the British Medical Journal concluded that the country’s rise in C-sections was driven primarily by unwanted procedures rather than personal preference. And some women elect to go under the knife only after hearing about the rough treatment of mothers who choose the alternative.

"Here, when a woman is going to give birth, even natural birth, the first thing many hospitals do is tie her to the bed by putting an IV in her arm, so she can't walk, can't take a bath, can't hug her husband. The use of drugs to accelerate contractions is very common, as are episiotomies," Maria do Carmo Leal, a researcher at the National Public Health School at the Oswaldo Cruz Foundation, told the AP. "What you get is a lot of pain, and a horror of childbirth. This makes a cesarean a dream for many women."