Hi Susie, I also want to avoid tearing:) I have some compromised(aka scarred) tissue down there and I'll try anything to avoid the need for stitches again. Here's some of my plans:
-during second stage use positions that slows exit, such as side laying or hands and knees. NOT squatting as this usually SPEEDS up second stage. 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 simply because they can SEE things properly?? NO. Much more comfortable and efficient to use your own hands cause you can immediately stop stretching/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. I won't resist my body's pushing (which would restrict the tissue from optimum stretching) but I will not voluntarilly contribute to it...UNLESS my goal is not to keep things slow and gentle on my bottom. It might change if for any reason I know it is vitally important to get babe out asap I will do all I can stand/squate assist my body in pushing. I don't anticipate that need will arise but if it does, I obviously will put my bottom's best interests 2nd to baby's best interest, kwim :)
I look forward to more mamas with input. Anyone here with thick scar tissue go on to birthing intact?