J.P.
Ok, so having coached MANY women over the years in natural childbirth and having had 3 unassisted waterbirths at home - and currently planning a 4th - I have some ideas. Don't worry, I'm not even close to talking you into a homebirth, let alone an unassisted. I always tell moms to labor and deliver where you feel comfortable. Me? I am comfy at home, but I never put that on anyone.
In fact, one of my friends decided to do a an unassisted homebirth at about 30 weeks. I told her I would be there, if my schedule allowed it. Turns out, I was out of state and she was 12 days "late". I told her labor would start go fast, when you are "late." Well, it did. She ended up delivering a 12 pound baby boy, no tearing, AND he's only 5'1". Her first birth at a birth center was a nightmere and had major complications. I can't tell you how thrilled she was for listening to her body - since she would have been a c-section for a baby that big at the hosptial.
Ok, so....
1) Don't go to the hospital too early. Once the contractions are about 5 minutes apart for 30-60 minutes, you may want to consider going to the hospital. The less time you are there, the less interventions they can start. If the hospital is close, I tell mom to wait until she feels a little pressure in the perineum before going to the hospital.
2.) Make sure you like your nurses. People don't realize that the nurses are the ones who can make or break your labor and delivery. Praise your nurses. When you get there, tell them, in a nutshell, what you'd like to acheive and ask them to support you in those decisions as much as they can. Be prepared for 2-4 nurses and bring a box of candy for each. The nurses are the unrecognized heros of labor and delivery.
3.) Drink plenty of water and pee often. Make sure you eat something, if you are hungry. Non per os, is outdated. Modern anaesthetic is not like it use to be. if you end up in surgery, they are still going to do it. The example I give is: if you are coming back from lunch and get into an auto accident, they medic team is not going to deny you surgery due to your full stomach. Same goes with c-section, if necessary.
4.) Listen to your body. Lying on your back is the WORST position for mom to labor AND deliver in. Look at a pelvis sometime and see that the sacrum HAS to move out of the way to make delivery easier. If you are lying on it, it can't move. Many women break their tailbone (coccyx) because it needs to move, but it can't....so it breaks. Delivering on your side or hand and knees, even in a squatting position, holding on to the head of the bed can be really great. The best position for the doctor is on your back, but this isn't about him/her.
5.) Push to the point of comfort. If the pushing gets too intense, then stop pushing, allow the tissue to stretch and then push again when it feels right. Stop watching the damn monitor and listening to a doc tell YOU when to push. (I delivered a 10+ pound baby with a nuchal hand - and when I felt too much pressure on the clitoris, you bet your butt I stopped pushing....and waited. I delivered him alone without ANY tearing...because I could feel everything and no one was telling me what to do...except me.)
6.) The contractions may start off like menstrual cramps and then increase in pressure. You should be feeling most of the contractions in the lower uterus. If you start feeling them in your back, then labor on your hands and knees and have someone/doula push on the top of your sacrum during contractions. Also having your husband squeeze the top of your hips together can be really helpful. Whatever you do, STAY OFF YOUR BACK.
7.) Once you hear yourself say, "I can't do this anymore," realize you are in transition and are about to push that baby out....don't ask for the drugs....you are almost there.
8.) Take one contraction at a time. Don't think about 85 hours ahead...think about this one and breathe. When making noise, chin to chest and make LOW sounds. High sounds cause your body to tense up AND it will give you a sore throat.
9.) Better to tear than have an episiotomy. Just like in sewing, you can get piece of fabric and you make a little cut, then you can tear the entire thing from stem to stern. If you tear without the cut, then it usually salvages some of the nerves and it's usually not as bad. Consider doing perineal massage every other night starting now until teh birth. It only takes 2-3 minutes. Some people say it does nothing, but what if it does? It can't hurt. Use something nourishing like vitamin E, rather than Astroglide. If you tear, a lot of the healing has to do with how the OB stitches you up - and I have seen some pretty horrible jobs.
10.) Breathe. Ask questions....even if someone makes you feel stupid. You can always get a second opinion from another doc. There are no do-overs...so make informed choices and trust your instincts. Realize that this birth will not be the same as your last. Write in a journal, type up something on your computer. Do whatever you need to do to release the fear, so you are not bringing that into this birth.
Keep us posted! Just remember to breathe and trust your instincts.