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Hiatal/umbilical
You will be in good hands with Dr. Schwaitzberg.
My take on this is that you have a diastasis recti (from pregnancy with a large baby), umbilical hernia (also can be from the pregnancy, and/or genetic), hiatal hernia (is this proven? can be from increased abdominal pressure due to pregnancy, abdominal weight, genetics, or other issues). I am not sure why you still suffer from the perineal tear during childbirth, as it has been 3 years.
You have so many abdominal wall and pelvic floor abnormalities, I wonder if a) your nutrition is up to par. Has anyone checked for your albumin, nutrition status, zinc levels, etc? and b) if you have a genetic predisposition toward lower collagen level. Any family members with hernias? Are you hyper mobile at the joints or do you have hyper extensibility?
Given all of these findings, choosing no mesh may not be in your best interest, as sewing tissue that is naturally weak and low in collagen is likely to fail and recur, causing more pain. I defer to your surgeon to help determine a) what are your main areas of pain, and b) what are the best surgical options.
If you are overweight, then weight loss will dramatically improve your symptoms, as any reduction in abdominal pressure will help reduce symptoms from hiatal hernia, umbilical hernia, and diastasis recti.
A tummy tuck is the most obvious choice for patients with very large diastases, with or without umbilical hernia, with possible mesh placement. However, this may worsen any symptoms related to a hiatal hernia, so once again it is important that a surgeon, of the caliber of Dr. Schwaitzberg, evaluate all of these issues together.
Best of luck! Keep us updated as to what the plan of care is proposed for you. There are a lot of great doctors near where you live, so also don’t be afraid to get second and third opinions.