With DS1 I had a CNM and delivered in a hospital. My one major regret is that despite my birth plan saying I did not want coached pushing on my back, that's what I got. And I wish I had spoken up, DH had, or the doula had. My legs were sooooooo sore the next day (like I had run a marathon) which has not been my experience w/ my other two kids. I *hated* the counting and coached pushing. DS1 was out in 20 mins, I had only a small tear that took a few stitches, but I think I might have avoided that to a degree if we had skipped the coached pushing in a semi-reclined position (name of actual position escapes me). I did NOT enjoy that approach at ALL.
DD was born at a FSBC and I really spoke w/ all of the CNMs there about my previous experience. With that birth I pushed in sidelying and followed my own urges. 2 little pushes and she was out. No counting. I did tell them some verbal instruction was okay to prevent tearing (like ease up...blow...etc.). No tearing that time and much more comfy.
With DS2, I had a home waterbirth and was kinda sitting with knees bent when he came I think? No tears. No check to see if I was "complete" (only cervical check was when CNM arrived and I was 5-6 cm). No coached pushing or any "direction" from the CNM. 2 pushes with one contraction and he was out. Easiest recovery...no need to use a peri bottle, etc. and never had any swelling in my perineum.
eta: totally look into all 4s, sidelying, supported squat, etc.
Mama to DS-2004
DD-2006
and a new addition-ds born march 2010