First-time mother Trisha Lawrie researched the impending birth of her daughter as though she were preparing a lesson plan for her high school English classes.

She read every book she could find, focusing particularly on materials that provided information on how to avoid Caesarean sections. She hired a doula and started Lamaze classes with her husband, David.

She also prepared a birth plan, a list of preferences that she wanted her midwife to follow during labor and delivery.

Unfortunately, Lawrie's best-laid plans took a startling turn after her water broke. A series of events chipped away at what she considered the most monumental event in her life.

Lawrie found the birth clouded by all the things she had tried to avoid: drugs to start contractions, an epidural, a failed vacuum extraction and ultimately a C-section that prevented Lawrie from holding her daugther, Camryn, seconds after the 7-pound, 1-ounce girl entered the world.

Both mother and daughter are healthy and happy, but Lawrie found the experience so traumatic and unsettling that she joined the International Cesarean Awareness Network, a nonprofit organization whose goals include lowering C-section rates through education.

Whether Lawrie could have stuck with her original desire to deliver naturally instead of following the advice of her midwife is difficult to say. As a first-time mother, Lawrie said she was too worried to argue when her specialist decided to admit her to the hospital last fall before she had even begun dilating.

What is clear is that birth plans, which are not considered binding agreements, may go by the wayside when a delivery doesn't go normally.

It's also worth noting that while birth plans encourage expectant mothers to communicate their wishes, not every doctor embraces them.

Dr. Sarah Pasqualone, an obstetrician in Willoughby Hills, Ohio, in practice for 12 years, doesn't allow them.

"Usually, women with birth plans have not been through labor delivery before," Pasqualone said. "Some of them are too strict on themselves about what restrictions are OK. They want to walk as freely as possible, or they don't want us to offer them an epidural. And they feel they have failed if all those things don't fall into place."

Dr. Marjorie Greenfield, the Cleveland author of "Dr. Spock's Pregnancy Guide" (Pocket), said long and detailed birth plans are viewed by some as unrealistic and disrespectful of a patient's physician "because your physician is supposed to know enough to do the right thing for you."

And if a woman is with doctors whose practice routines are not consistent with what she wants, writing a birth plan won't change that, Greenfield said.

"If you feel strongly about the type of experience that you want, if you want a lot of input, if it's important for you to have things kind of low-tech and as spontaneous as possible, it makes sense to not choose a practice with a 40 percent C-section rate," said Greenfield, whose new book, "The Working Woman's Pregnancy Book" (Yale University Press), comes out in May.

About birth plans

When preparing a birth plan, these three major areas should be covered:

• What are your wishes during a normal labor and delivery? These range from how you want to handle pain relief to enemas and fetal monitoring. Think about the environment in which you want to have your baby, who you want to have there and what birthing positions you plan to use.

• What are your hopes for how your baby is treated immediately after birth and for the next few days? Do you want the baby's cord to be cut by your partner? If possible, do you want your baby placed on your stomach immediately after birth? Do you want to feed the baby immediately? Will you breast-feed or bottle-feed? Where will the baby sleep — next to you or in the nursery? Hospitals have widely varying policies for the care of newborns — if you choose to have your baby in a hospital, you'll want to know what these are and how they match what you're looking for.

• What do you want to happen if there are unexpected events? No one wants to think about something going wrong, but if it does, it's better to have thought about your options in advance. Because some women need Caesarean sections (C-sections), your birth plan probably should cover your wishes in the event your labor takes an unexpected turn. You also might want to think about other possible complications, such as premature birth.

Source: KidsHealth