An episiotomy is not always needed when vaccuum is used- but most drs will cut out of habit.

Were you able to move around in labour the first time? Do you think the episiotomy and vacc were needed?

i don't know much about epi-no, but (if you can reach) you can do your own stretching of the perenium. Read up on positions during labour that help to get bub out, warm cloths on the perenium when bub is coming out can help, taking your time to push bub out, listening to your body. Let your health care providers know that you don't want to be cut. Tears don't always need to be sewed, and often heal better if they are not.

I was cut with my first bub and i felt it, it was horrible. My midwife knows that i do not consent to being cut and we will do things that will minimalise the chances of tearing.