Can you make an appointment with a midwife to go through your concerns and have your wishes noted in your file? I think you'll probably find that they're quite willing to support active birth and it'll ease your mind.

Remember, you have every right to birth the way you want to and at the end of the day you're the one who has to live through the experience and live with it for the rest of your life - so don't let anyone bully you into pushing before you're ready or getting into a position you're not comfortable in. Public patient or otherwise, you have every right to birth how you feel comfortable, no matter whose time you're 'taking up'. Any care giver who tries to bully you does not have the right to be in your birthing space. No one can do anything to you unless you consent to it, so you have that on your side too. And no-one can force you to push either, if you don't feel ready to push, just don't push. If they become insistent, I would tell them to leave the room! (or get my support person to!). It's not like you're going to hold the baby in forever; when your body is ready, baby will come!

With regards to tearing, you're *more* likely to tear if you push before you feel the urge and follow their directions, so that's a very good reason to not crumble that you can file in the back of your mind :-)

Who is your support person? Do they know how you want to birth? Have you voiced these fears to them? Will they be willing to argue for you if need be?