Day One was exciting. It was a carnival atmosphere and somewhere on the web, it was stored for posterity. I think the link will eventually be here:

http://consensus.nih.gov/2010/vbac.htm

If you hurry, you can preorder the statement that will then go on to help or hinder VBACs in the United States.

So many blogs are discussing yesterday and the excitement and hope and the acknowledgement of women and their voices that I am posting them all in a separate post in the hopes that I'll be able to give women a rounded opinion of everything that went on yesterday.

So this morning I wake up and my thoughts for the day that I am carrying with me are as follows:

How many Elephants in the room are there? Physician's ethics (that the moderator kept telling us they can't MAKE them practice ethically!), hospital policies (and the moderator kept telling us they can't MAKE them practice ethically!) and homebirth.

I think the homebirth elephant got to get out of it's pen and roam around the room a bit. So where is my thought process as I try to sleep and try to wake for the day? It's here:

If the committee/panel never looked at specifically homebirth statistics (not just studies, even the statistics are telling) or birth center statistics and studies for themselves, then how will they be able to go with a finding that validates the immediately available standard for hospitals and then apply it to homebirth by confirming it? They have not availed themselves of all of the research and have no idea what happens when immediately available is not immediately available and therefore, how to handle such an emergency or what it's outcomes would be.  There should be some acknowledgement here of why women are choosing homebirth since it is the hospital's policies, the OB's policies and the standard of "care" that we receive (or can't even partake of!) that drove many women from mainstream into the arms of homebirth and personal responsibility. While the committee may not be able to take on the safety and efficacy of homebirth VBAC, can they at least state that yes, it is occurring in wider numbers in order for women to give birth without acquiesing to unnecessary major surgery? Can we not commend those who have not abandoned our care but instead, are making sure that women are attended in the process rather than being forced to go back alley? And what about the women who are being forced to go back alley? Do they not deserve some sort of recognition as well? I can think of a dear woman right now being faced with pregnancy in an illegal state and whose choices can only be defined as untenable. Unassisted or cut.

And after hearing several of the panel members discussing the fact that women deserve the right to choose their own risk structure and analyse the data and make their own determinations, how can this not apply to homebirth as well?

Let's at least give the homebirth elephant a name in this room. Let's call it...

Personal responsibility. You give us the facts and informed consent and we'll  make our own call on whether or not homebirth VBAC is safe. Until then, stop pretending like if the OB community doesn't notice it, we're not doing it.