When I was pregnant I found out two of my friends had episiotomies against their will (not wishes- against their will, literally). They/I liken this to sexual absue and thus when I looked for a midwife I made this a clear part of my birth plan. I had a tear that required a few stitches from my midwife. Honestly I was fine with it-- I don't think there's anything I could have done to prevent the tear, my midwife, support person and doula all did a wonderful job helping me stretch, I just think it was meant to be.
I took no pain relivers and was fine-- really, I know this sounds weird with stitches and all, but honestly I didn't have pain beyond the slight burn when peeing for 24 or so hours.
The only issue I had was that I had to really fight off the nurses (I had a CNM birth in a hospital) to examine the stitches. I think I may have screamed at one woman, honestly
: but it felt very private.
Personally I would never chose an episiotomy for the reasons other women mentioned- tears heal faster and quicker and "preventative" epis are usually only good for the doctor. Plus, being a survivor, it would feel like too much of a violation of my body.....
I saw two midwives, at a hospital, and between them they did 2 epi's in the year before I saw them- both were requested by the mothers.