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After rising steadily for the past 30 years, the rate of infants born through Caesarean section in the United States remains "extraordinarily high," a government researcher said.

A study by the National Center for Health Statistics found the Caesarean rate during 1981 through 1986 to be 23 per 100 hospital deliveries - more than twice the rate in England and the Netherlands and more than three times the rate in Japan.Only Brazil, with 32 Caesarean sections per 100 deliveries, and Puerto Rico, with 29, had higher rates than the United States out of 21 countries studied, researcher Francis Notzon wrote in an article published Tuesday in the Journal of the American Medical Association.

A Caesarean section is a surgical procedure in which the abdomen and womb are cut open for childbirth. It is performed when conditions exist that could make normal, vaginal birth dangerous for the mother or her baby.

Despite the sharp differences in Caesarean rates from country to country, "no significant association" exists between the frequency of Caesarean deliveries and levels of infant mortality, Notzon said.

In Japan, for instance, infant mortality in 1985 was slightly lower than in the United States, despite the substantially lower Japanese Caesarean rate, Notzon found. While such comparisons are "imperfect at best, this does indicate that low levels of early infant mortality can be achieved in some populations despite a low rate of Caesarean deliveries," he said.

After two decades of consistent increases in Caesarean sections in Europe, North America and certain Pacific countries before 1980, Notzon found the rate slackened after 1980. While the average increase was 8.7 percent annually from 1976 to 1980, it slowed to 4.6 percent from 1981 to 1985.

Nevertheless, if the current annual increase in Caesarean rates continues in the United States, the number of procedures carried out per 100 deliveries will double in 11 years, the study found.

Notzon said the figures raised questions that should be addressed in future studies. He said one question concerns why there was a slight drop between 1980 and 1985 in Caesarean sections performed in the United States because the fetus was in distress, while the proportion of births diagnosed with fetal distress rose from 2 percent to 6 percent during the same period.