To the OP, i had a vacuum with DS, and no episiotomy. I would go with vacuum, forceps and then a c/s. I think that would be the order of a more difficult recovery. In terms of them not being as skilled any more, that is true, but you would be hard pressed to find any single doctor who will do a mid or high forceps anymore (and if you ask anyone but an older nurse, they don't even know what it is anymore, because they will never have seen one). They are hard to learn apparently (my mum is a mid and she told me about them), and you can stuff it up big time learning, so now the risk isn't considered worth it and they will c/s those patients instead. But perhaps the loss of skills in the obstetrics field in favour of c/sing women to avoid litigation is a discussion for a different time?

I would think you are no more likely to have a stuffed up epi than a stuffed up c/s, and the would both suck. I would take a vacuum or forceps over a c/s, because like Kelly said, the impact on future births is huge.
I would think the vac without epi is probably now looking more favourable. I know my older sister had a forceps assisted with her first but she wont talk about it - and she is an extremely open person so I can only imagine that it is a trauma she does not want to revisit. An epi is performed around some seriously important muscles and I have put a lot of effort to keep my pelvic floor in good shape after grand multiparity. I still have MWs marvel at the fact that I have avoided ever experiencing incontinence, and its a freedom I want to keep with soon to be 6 kids to look after. Not to mention the other muscles which I really dislike the idea of putting that close to a surgeons blade with me freaking out on the table.

Its funny, but of the whole birth preferences, I never imagined that the bit that I probably wouldn't need would be the hardest part to write.