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The office is immaculate, as you would expect in an upscale neighborhood in Sao Paulo — all sterile, white, modish plastic furniture and green plants. Behind the reception desk are pictures that would look more appropriate in a pop art gallery than a private maternity clinic.

The list of services at the clinic in Brazil's largest city is long: fertility treatments, specialized gynecology and, of course, obstetrics. But one thing they rarely do here is preside over a vaginal delivery.

Dr. Alexandre Sasaoka struggles to remember the last time he assisted at one. We do them, he says, but rarely.

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