With DD, I was facing these three options... except my Obs hadn't mentioned c-sect, but it was in the back of my mind.

She said she wouldn't try forceps without an epidural so we went with vacuum. I'd never go for c-sect unless it was absolutely necessary. My recovery from the vacuum and episiotomy has been straight forward, give me that over major abdominal surgery any day.

Oh and the Obs tried the vacuum without an episiotomy first - so I think it is possible.

Also my recovery from the episiotomy has been better and cleaner than my sister who had a few tears and grazes from a delivery without an epi.