To tear or not to tear

There's something about child birth that's not often talked about so that it doesn't scare you. Human babies are born three months premature compared to our primate relatives. New born babies are all head, all brain, and not ready for action in the physical department. They are so floppy!
Basically, human evolution is skating a knife edge. We have got to the point where, on the balance of probabilities, child birth won't kill a mother so long as the babe is born at 40 odd weeks. We couldn't survive and give birth vaginally if babies were to be nurtured in the womb for that fourth term - their heads would be too big.
So, child birth won't kill you. But you don't come off unscathed, either. We only recover from it as well as we do because we support each other in a society. We have people who know what to do to help you birth with as little damage to you as possible, and people who know how to help you if you do suffer injury.
If you ask your mother, she most likely had an episiotomy, or tore if she had a natural birth. If she had an obstretrician and private health cover, she will have had an episiotomy as a matter of course, perhaps even without her consent. In medical circles it's taught that giving routine preemptive episiotomies is better than letting the woman run the risk of tearing. This is because conventional wisdom says that a clean cut heals better than a tear.
Not every one agrees with this approach - if you don't tear, you don't have to heal at all. And just because you do get cut doesn't mean you won't keep tearing - in this instance, your tear will be even worse. Whatever the case, episiotomy or tearing, child birth is a savage initiation into motherhood. Having a new baby clamber over your breasts searching for a nipple whilst a team of people hold your bits together and stitch you up is a surreal and overwhelming experience that I have difficulty recommending.
I tore giving birth to my baby's shoulders. I was so sensitive, I had to have two rounds of anesthetic - they couldn't give me any more than this - and use gas for them to stitch me. Even then, I could feel every stitch, and screamed throughout. In terms of healing, my tear healed up just fine. Unfortnately other complications arose because of the trauma but I think these would have occurred whether I'd torn or had an episiotomy. I was just extremely unlucky - my obstretrician may only see one or two women like me a year.
You've got to make the decision for yourself whether or not you will have an episiotomy. Giving birth in a position other than on your back, such as all fours, will make a big difference. Effective also are warm moist compresses applied regularly to the perineal region during the labour. Best of all is giving birth in water, because then your perineum is supported.

What decision have you made?