Nuchal hands/arms=ouch, in a big way! This leads me to wonder if everyone tore badly too (multiple 3rds here)...
Also, it took me 6 hours to push her out. She was my first, but I really feel the hand really kind of got us stuck a bit for a few hours. When I finally pushed her out, I did it on purpose - I was draining, and I was worried about my poor baby's head going through all that, and I psyched myself up (and announced to everyone that the next push was going to be "the one"), and the next contraction I kept pushing even after the contraction, and harder than the contraction was pushing on its own. I realize you're not "supposed" to do that, and no doubt that's when I tore, but I have never regretted it; baby and I were getting tired.