Well, I'm back to report the outcome of my second birth after a 3rd, almost 4th degree tear with extensive vaginal tearing, torn labia on the left side, a cervical tear and torn artery with extensive blood loss last time around (4.5 years ago).
I did a ton of research and soul-searching and asking the mothering forums before finally deciding about 25 weeks into my pregnancy that I would try for a home birth. I talked though my issues with a few midwives, and agonized a bit over which one to choose. In the end, I went with the one who had been home birthing the longest and who was very hands-off. In the end I am not sure I wouldn't have been better off with one that was a bit more proactive, but I can't change that now and will never really know...
My first baby was 7lbs even with a 34cm head, which is pretty average, maybe even a bit on the small side. I am not a tiny person either. My labor was in a hospital, with epidural and pitocin, I pushed twice and the baby flew out. I felt the meds were much too strong for me.
I was advised this time to go to an osteopath who could massage my perineum over the course of several appointments and get my scar tissue to soften up. Honestly, the thought of this freaked me out, and I decided to try perineal massage myself but ended up doing it only twice before taking some midwives' advice that the perineum will eventually open up no matter what.
This time we set up a pool in our apartment, I talked a lot about laboring and possibly birthing in the pool, and this is what ended up happening. My labor was fast, the midwife arrived at 11PM and I was at 6cm, and the baby was out at 12:15. During pushing, I was hyper-aware of what was going on because I was so afraid of tearing badly and losing as much blood as last time. I felt the baby's head move from what felt like my butt-area, forward to my perineum, and then even further up with most pressure upwards towards my labia. I felt the perineum and it was not giving! It felt like it held tight and neither tore nor stretched. The head was pressing forward and I felt I was starting to tear. I told the midwife, and she said "no, you are fine, you will not tear, just relaaaaaaxxxxx....." I felt she was not really "with it" at this time, and was just going through the motions of telling the woman in adrenaline-fueled transition to take it easy. I told her again "no, my perineum is not stretching, I am tearing forwards!" At that point I felt a bit humored and thought to myself "this woman is not helping me, my husband doesn't know what to do, I have to decide now to either push this baby out and take the tear, or sit here in limbo!" So I pushed against the pressure of the baby's head and tried to guide it downwards as I pushed. After about 4 pushes, she popped out. I felt the sting of the upwards tear contrast with the relief and gentle feeling on my perineum as she came out.
I ended up tearing my left labia almost clear off, and had maybe one stitch in my perineum. None of the places I tore last time (which was pretty much everywhere else) were affected this time. It is now 10 days after the birth and I feel pretty much back to normal. Last time it took me 8 months to feel no more pain.
All in all, I am glad it went so much better than last time but still a bit disappointing that this birth did not heal my fears about tearing. I keep wondering if I am just a "tearer" and this will happen with any subsequent birth. In any case, I am so glad I went for a home birth. I feel that being at home allowed me to heal so fast, and I realize now how much of those first few days of my son's life I missed by being drugged up in the hospital.