Hi R.,
There is a LOT of advice that you could get because each experience is unique, and everyone will want to tell you how THEIR way is the best way. :-) Even now, I'm tempted to do it. I want to say - DO WHAT I DID - IT WAS AWESOME!! But ultimately, each of us sharing our experiences and in turn you doing some research and asking questions to your doctor/midwife will ultimately determine the route that you feel comfortable taking. I agree with much of the advice that I have read so far, in that a lot of it is your mindset going into it. With my first, I was PANICKED (before I even started labor) so when I arrived at the hospital with my contractions piggy-backing and coming every two minutes and found I was already 9+cm, I said, "CAN I HAVE AN EPIDURAL?!?!?!?!?" The reason it was the first thing I said despite being so far along in the process was b/c it was actually not as bad as I had feared, so I assumed the worse was yet to come and BEGGED for the epidural. I had NOT talked with my midwife (I HIGHLY recommend midwives, by the way) at length beforehand (not b/c she didn't try but b/c I didn't know what to talk about...I thought there was no way I could manage the pain so I automatically decided I wanted an epidural and knew that my midwife would encourage me otherwise and didn't want her to b/c I was so terrified of the process), so they pretty much just told me that I might not get one before my body was ready to deliver but they would at least start the process. Well, I got one and had it for about an hour before I was fully dialated and ready to push. It had its benefits in that I could relax and joke around with my hubby and midwife, but the negative side to it was that I really didn't know how to push. I mean, I tried my best, but not having the sensation down there really inhibited my ability to efficiently push. I pushed for quite some time and had some pretty rough tearing, which took MANY MONTHS (almost a year) for me to feel "normal" again. So, it's something you'll have to research b/c I'm sure that doesn't happen to EVERYone. My second birth, on the other hand, I was VERY open with my midwife (I go to a group, so this was a different midwife than my first delivery), explaining to her that I was more afraid of the tearing than I was of anything else, and that the healing process was so long and complicated and all sorts of other horrors that accompanied it... WHAT WERE MY OPTIONS?!?!?!? I had heard that warm compresses during labor/delivery were helpful and perineum massages prior, etc., so I asked many questions the second time around. I also told them ahead of time that I wanted to do the natural route this time, etc. etc. Well, my second experience (although 2nd births can often be easier) was SO much better. I had minimal tearing (like another post said - comparable to a split lip) which I never even felt during delivery OR recovery. I felt SO good afterwards that I was ready to just go home (although I still stayed the standard two days). One of the things that my midwife did to keep my relaxed was having the lights dimmed and she put some lavender oil on my clothes/hospital gown. I don't know how much that helped, but I certainly appreciated it and her overall demeanor was SO calming. She did use the warm compress as well, and I believe that also contributed to the overall "easiness" of the delivery. Breathing definitely helps during the contractions, although for me that fast breathing never did - just slow and concentrated. But then again, I never TRIED the fast breathing b\c the deep and slow was working so well for me. I would count how long I would breathe in and out for b/c the counting would distract me somewhat from the duration of the contraction. Anyway, I digress... Sorry about all the details! Another thing that I had discussed with my midwife prior to delivery was birthing positions. She knew that I was terrified to tear like I did the first time, so she recommended other positions than back lying. She said that position is MOST conducive to tearing. You'll have to discuss this with your midwife, but I did deliver on all fours. I know - strange! When she first mentioned it I thought it was WAY out of my comfort zone, but when the time came, I didn't even think twice about it. She asked me if I wanted to try it and I think I didn't even answer her. Just moved into that position between contractions. There is less gravity on the perineum in that position, so less likely to have intense tearing. Lastly, work with your body and LET IT deliver the baby and you will likely have minimal or no tearing. Often that is a midwife's approach as well. Not just pushing b/c you are fully dialated, but letting YOU determine when to push (for the most part) b/c your body really does it for you - it's like it just goes into autopilot and works that baby out for you. This isn't an option with the epidural though...
Anyway, long story short - do some research online and read up on everyone's posts and see what might seem to be a comfortable (mentally, of course) option for you. Talk to your midwife (if you don't have one, see about finding one b/c I think their approach is very different than that of a dr), ask lots of questions, and just enjoy the process. No matter what happens, it will still be one of the BEST experiences of your life, simply b/c you are meeting your little child for the first time and its just an amazing experience overall.
Best wishes for a healthy and happy delivery! Sorry for being so verbose!