Hi - i birthed upright, kneeling in the shower - I didn't tear at all. the midwife could see everything via a mirror they placed underneath me (the water was running and if they had actually looked they would have been drowned). It isn't actually necessary to support the perineum anymore - if the midwife is confident in her practice by viusally viewing the region she would know when there is a need to support the area. Anyway, as I said, I didn't tear and I really think it was my position that helped with this. Anyway, also goes to show that you don't always tear in this position.