I don't know of research that examines the effect of laboring itself when a cesarean delivery is already planned (ie, does forgoing the hormonal changes during labor alter breastfeeding outcomes, apart from the typical difficulties encountered with c-sections and possible iatrogenic prematurity?)  Might be very difficult to study that on its own, as there could potentially be so many confounding and variable factors (length/stage of labor, type of analgesia, indication for c-section, etc).

That being said, the scenario presented here is very VERY common.  I have never actually had a patient arrive to L/D in spontaneous labor who had planned for a c-section (whether primary elective, repeat cesarean, breech, whatever) who did not already have a date scheduled.  I don't know any OBs who wouldn't get a date on the calendar, and moms really like knowing that their OB is going to do the delivery.  Honestly, convenience IS the greatest factor here, for the physicians, the staff on L/D, and the patients.  Not defending it or saying that it's right, that's just how it is.

It happens with some frequency that a mom shows up with a c/s scheduled for the next day or week or whatnot, but is in labor and needs to be delivered earlier.  I always feel bad for these moms because as long as baby is looking great, they are kind of shuffled to the "end of the line" as far as triage on L/D.  As the anesthesiologist, I need them to be NPO (nothing by mouth) for 8 hours as long as it's not an emergency so very often that is the limiting factor as far as when we can actually do the c-section.  So they sit there laboring and hungry and we normally don't start an epidural or provide pain relief until we're actually ready to go (so as not to complicate our dosing for the operation and help ensure the best block we can get).  And because it's not an emergency, there is usually some delay or another patient requires more urgent attention and things get pushed back.  And then everyone -- mom, dad, nurse, OB who's there on call, anesthesiologist -- is annoyed and tired and it's now 3am and we're doing surgery.  

When this happens, it happens and we deal with it.  But *everybody* (except the baby, no?) is much happier when mom and dad come in for their scheduled delivery.  I'm just happy they've shifted it to at least 39wks.

The moms in question could just not show up. :)

-Sarah Reece-Stremtan M.D. (anesthesiologist in Washington DC, current stay-at-home mom, and soon-to-be pediatric anesthesiology fellow where I can hopefully avoid the labor/delivery floor for a very long time)

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