– By JULIANA BARBASSA

The Associated Press

RIO DE JANEIRO – From the day Mariana Migon discovered she was pregnant, she knew she wanted a natural birth. So just weeks before her due date, the first-time mother abandoned her obstetrician, her health plan and her private hospital room for the free public hospital in downtown Rio — where she had a real chance at a vaginal birth.

“If I’d stayed with my health care plan and my doctor, I would have had a C-section,” said Migon, as she sat beside the incubator holding her baby girl, who was premature.

In Brazil, where natural childbirth fell out of favor years ago, more than half of all babies are born via cesarean section, a figure that rises to 82 percent for women with private health insurance.

But that trend may be turning around.

In a nation that has among the highest cesarean rates in the world, women are pushing for more of a say in childbirth — whether by C-section or naturally, at home or in a hospital, with a midwife or a medical doctor. As patients in doctors’ offices and in street protests are starting to reject a national preference for surgical births, the federal government is investing billions of dollars into a natural childbirth campaign, including the building of hospitals devoted to maternal care.

“We need to have a serious discussion in this country to see what can be done to change this culture,” said Olimpio Moraes Filho, one of the head doctors with the Brazilian Association of Obstetricians and Gynecologists. “Women are starting to rebel, and they should.”

A tipping point came in July, when a medical regulating agency in Rio de Janeiro forbade doctors from doing home births and labor coaches known as doulas from helping out in hospitals, saying, “There are many complications possible during labor that require immediate medical attention.”

In response, women organized marches in 13 cities. In Sao Paulo, they bared their breasts and carried posters reading “Our Children, Our Decision” while chanting, “Brazil, don’t follow Rio’s example.” They enacted natural births using dolls covered with Portuguese words reading “Born Free.”

After the resolution was reversed by court order July 30, about 200 people gathered in Rio to celebrate, with yet more banners and painted bellies defending women’s freedom to choose how their babies are born.

Similar marches took place in 28 other Brazilian cities, where women also defended their right to reject episiotomies — cutting the vaginal opening to prevent tearing — and to have company during the birth. A 2005 law says women should have a companion of their choice during labor, but it’s frequently not respected.

The World Health Organization warns against unnecessary surgeries, saying that while there is no ideal C-section rate, the percentage should hover between 10 and 15 percent. In China, which also has a very high cesarean rate, 46 percent of babies were delivered by cesarean in 2008, the latest year for which data is available. In the United States, more than a third of births are by C-section.

Because a C-section entails major abdominal surgery, risks for the mother include infections, complications from anesthesia, hemorrhage and dangerous clots, and a longer recovery.

For the baby, the procedure is linked to increases in premature births, breathing problems, and generally lower health scores related to depriving babies of the stimulation they normally experience as they travel through the birth canal.

The reasons behind Brazil’s high rates are many. Experts say a longstanding interventionist approach to vaginal births made them more painful and stressful than necessary. All this gave C-sections a reputation as being a more predictable, painless and modern way to deliver.

Brazil’s statistics worry Maria do Carmo Leal, a researcher at the National Public Health School at the Oswaldo Cruz Foundation. She is analyzing a survey of 24,000 birthing mothers across the country and said the high C-section rate reflects an extreme manifestation of a medical culture that treats delivery as a health problem and not as a natural process.

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