Not only have I had big babies, but they've come out in weird positions!
My first was my biggest, although he weighed the least (as you know, fat squishes!
) He was 40w 4d, 8lbs 8oz, 22"long, 14.5" head. He was posterior w/ a nuchal hand. I squatted during most of the 2 hours I pushed, but at the end I was exhausted and although my OB asked me once or twice (she was very non-pushy and hand's off--a great midwife more than an OB only she took high risk patients and her c-sec rate was I think 6%) to try squatting again, I had ds while I was sitting on my tailbone on the edge of the bed. Not one single tear w/ his head, I remeber the nurse saying "Look how wonderfully she's stretching!" as he was crowning, but I had a LOT of tearing w/ his shoulders/elbow (my doc told me to stop pushing so she could move his arm, but I couldn't stop.) He also had his shoulders "sideways" Not sure how to describe this, but his shoulders were parallel w/ mine when he was born instead of sideways like most babies are. I pushed for 2.5 hours. I had a completely natural birth w/ him. My doc gave me a shot before she stitched me up, but if she'd asked I probably would have told her not to bother.
I think the high you get from a natural labor is plenty for pain relief.
And if your baby has a nuchal hand and you're told to stop pushing--STOP! They can move the hand to a better place so you don't tear.
ds2 was 9lbs 4oz, my smallest at 38w 0d. 20.5" long, 14" head. I was in the stranded beetle position due to an epidural (afraid of my OB and mean nurses made my labor stop.) I pushed for 4 contrax. He was asynclitic (head cocked), shoulders in the normal position. I am 100% sure I wouldn't have torn since he was my smallest baby, but my sOB gave me a friggin episiotomy. His birth was very traumaizing for me.
Ds3 was 9lbs 6oz, 21.5" long, 14.5"head. Born at 39w5d. At home in the water.
My midwife says he was what they usually call an "Exorcist baby" (:rofl) b/c his head came out anterior, but his body was posterior, shoulders sideways again like ds1. THe only reason he wasn't an exorcist baby was that he didn't spin his head around like they usually do.
He just kept it turned WAY to the side instead of lining it up while his shoulders were born. He had a VERY tight cord. He had a lot of trouble getting started breathing and needed a lot of massage and trips to the chiropractor for his neck the first few weeks.
Btw, I'm 5'3.5 and I am small. I'm a little overweight now, but when I am at a healthy weight, I wear about a size 5 (haven't been that since ds1 was 18 mos old
) My midwife says I have a pelvis you could drive a truck through.