The pre-existing bias from the panel was incredible. The voices of the public who tried to contribute any alternative point of view were being ignored. About the only thing that was semi-reasonable was that they acknowledged that the risks of repeat cesarean increase with each one - but my cynical side sees this as being a method of bringing those of us who want large families into line with the ZPG crowd.
An acquaintance of mine who attended sent out the following email.
The passionate voices of professionals and consumers were effective at representing the alternative viewpoint from the audience, but we were unable to sway the panel away from its obvious biases, nor really even enlighten them that they were biased in the first place.
The final conclusions were actually reasonable, if you sift through the rhetoric and questionable "science" (ie., biased studies). Granted, the scientific literature is full of bad studies that say crazy things like breastfeeding rates at 3 months postpartum are the same for c/s (cesarean section) and svd (spontaneous vaginal delivery)women. Much of the Listening to Women data was conveniently dismissed as unscientific. In cases where svd safety clearly outweighs surgical birth (such as in the category of surgical complications), the evidence was framed in such a way that it recommended scheduled section over emergency section, even to the extreme implication that attempting vaginal birth is so strongly associated with emergency sections that it is reasonable to compare the safety data of attempted vaginal birth to scheduled sections.
Actually, in most cases they classified the available data in studies as "weak evidence" - however, not surprisingly, the "scientific" data presented on each of the following parameters FAVORED SCHEDULED SECTIONS: mortality, infection, hemorrhage/transfusion, anesthetic complications, infection, hysterectomy, thromboembolism, breastfeeding rates, postpartum pain, psychological outcomes/PPD. Sometimes the comparison was against attempted vaginal birth, other times it was between scheduled and unscheduled sections (such as surgical complications).
In cases where the evidence would unquestioningly favor svd, they used comparisons between scheduled and unscheduled sections, equating attempted vaginal birth with emergency sections, so that it ALWAYS favored scheduling sections. It was then implied by extrapolation that scheduled sections on request are safer than any other form of birth. By the way, the only outcome that favored svd over sections (with moderate evidence, too) is maternal length of stay. I couldn't believe what I was hearing!
Unfortunately, I don't think they every really got it that their premise and assumptions are wrong. It was exasperating to find that the entire community of NIH scientists are woefully unaware of world (and US) literature on best practices (ie, low intervention = midwifery practices).