Hi Natalie! I'm also new here. Well kind of, I have been reading for months and months- putting off registering..until I read this post and I just HAD to comment.
First of all I am soo sorry about your 'butcher job' and the subsequent pain that must have caused you both physically AND mentally. I'm sorry about the pain you suffered after your first home birth as well. I just teared up imagining that scenerio..sad toddler, dog.. panic....I'm so sorry. I am impressed with your courage and strength to go on having more kids!
I feel I can relate just a little. First of all, DS1 was delivered in hospital 3 hours after I arrived- I had felt labour come only about an hour prior. So pretty fast. The doc cut 2 episiotomies, the second I remember the sound as he kept cutting..snip snip snip. 3X. UGH. I hate what he did to me. During labour I had refused any pain killers just to end up being sent to the OR and given a spinal so the surgeon could do the repair on my 4th degree tear (aka "episiotomy extension" or in the surgeons words "gong show"). It took him longer than his usual 30min slot for that type of surgery.
I know midwives can do stitches and tears heal on their own, but, correct me if I'm wrong, but when skin, layers of different muscles AND ligaments are cut through they need a special type of repair that perhaps midwives don't deal with enough to repair optimally. Mind you, midwives rarely "cut" and episiotomies are the biggest cause of 4th degrees. If no episiotomies are involved it is very uncommon to tear so bad. Risk factors would be: forced pushing or speedy births (not speedy labours as much as speedy second stage-this is because your perineum, which has amazing potential to stretch, needs adequate time to open as wide as your baby needs it to) Picture your other muscles and their ability to stretch given proper warm up and continually stretching to that point of resistence and then easing off until your ready to comfortable stretch a little further. I could do the splits but it would take me at least 5 minutes of warming up, some lunges and hamstring string stretching, then some more working out and then slowly easing into the splits. If the next day someone was like, "you can do the splits? Sweet. show me!" And I immediately dropped myself to the floor I'm almost positive I would have torn something. In fact I think that exact thing happened when I was in Highschool! Anyways back to Labour. Your body needs time, But it CAN do it given the proper warming up and gradual stretching..and in Labour you have the added bonus of your body's natural release of hormones/chemicals that make you even stretchier down there. For one relaxin is a hormone your body starts releasing the moment you conceive and releases in huge amounts as labour progresses. This helps your body safely birth your baby!
IMO anything that reduces fear, increases relaxation and slows down the pushing stage would be the very best in terms of increasing your chances of keeping your bottom intact :) For me this would be:
-at home no stress of commuting
-easy access to bed, shower, birthing pool, toilet without the restrictions that i found in the hospital
-support person to help me change position IF i feel the need but dont have/want to use the energy
-position that slows exit during second stage such as side laying or hands and knees. NOT squatting as this SPEEDS. Yes it MAY speed stretching due to the direct pressure on perineum BUT on my compromised tissue full of scar tissue I WONT risk putting too much pressure. UNLESS i am in water and it feels comfortable- the water's counterpressure might be enough to keep things slow and gradual- I would assess this at the time but expect i will be most comfortable in a hands and knees like position in the birthing pool.
-no massage during second stage. Unless i am doing it (basically easing my own tissue if i feel the need) Someone else's hands simply cannot do what mine can even if they have the view and the best intentions they CANT have the sensory feedback as its impossible for them to feel what your perineum is feeling. Think: would you prefer someone else to insert your tampon cause they can SEE things properly?? NO. Much more comfortable and efficient to use your own hands cause you can immediately stop stretching or putting pressure on any area the moment you feel it hurts too much rather than having to say "stop" or "move to the right, no not your right, MY right" sorry if tmi but you get my point?
-I will have warm compresses and warm oils on hand in case it ends up that i prefer to be out of water. I will have my support person aware that altho i prefer hands off I MIGHT want them to gently apply warm compresses and towards the end very gently slather the oil as lubricant but no pulling or massaging unless i direct them too. Which i might if they are very gentle and it feels good.
-no forced pushing. Breathing calm and peacefully to keep my body as relaxed as possible throughout the "uncontrollable" pushing
-keeping a clear open mind and open to change of plans should I realize it is needed- not out of others' fears. But if my body tells my mind that plans need to change I will trust that and act
accordingly. I do trust I will know and that a calmness will help me and my support person do what is necessary should an emergency arise.
-After baby is safely born I will assess things. Hopefully my bottom will feel/look good. I think I will know If I need to go in for repair and If so, we will have planned for me to be transferred with very minimal movement on my part. If surgery is again needed I will not try to walk more than necessary, I wont try to suck it up and sit just cause i want to feel like i'm normal. I will lay out for another month+ if I have too. I will take it easy and be very gentle and kind with myself, giving that tissue the time/nutrition to heal well.
Anyways I think I understand your concern. You had TWO 4th degree tears! That is a very serious injury with far reaching affects that most people cant quite understand the severity of. I am really sorry. I would be weary of induction First because nothing can guarantee that baby is truly ready to leave that gentle first home and be ready to breath on their own. And second because that first intervention can affect your body's own coping mechanisms such as the the chemicals that can be released specifically to help you stretch enough. I wise doc once warned me how quickly interventions (such as pit EVEN in low doses) can snowball resulting in awful further interventions that were now necessary but most likely wouldn't have been if the first intervention had been avoided. And THIRD because I don't believe it will increase your chances of staying in tact. But only you know what you feel best about and if that is truly the choice that feels best for you. Good luck with everything! I look forward to hearing how everything goes for you :)