Remember this too - you are more likely to tear from fast pushing, if you have had an epidural and aren't sure how you are pushing, if you are on your back or if you are so tense and are keeping the area tightened in pain - just like when we tense up, we tighten our sholders, jaw etc. If you are okay with it, include in your birth plan that you want guidance at crowning, so the midwife can get you to slow down and let your perineum stretch slowly. There is a technique that Ina May Gaskin uses very successfully for this, it's hard to explain without a diagram. I'll use a TMI explaination here. When you do a poo, you don't shoot it out real quick or it would be painful (and sometimes you can get tears down there too!). Also, it's another sphincter in the body, one designed to open, close and does it become all loose afterwards? No it regains it's form! A woman's reproductive organs are amazing, natural produced hormones help them do what they need to do, stretch and then bounce back. More tears happen in hospitals than they do at home with a private midwife.
With the epi-no, it's important that you don't exceed the recommended amount of exercises as you can have problems with overstretching if you go overboard! Not pleasant ones!
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