Cb, I had an episiotomy the first time and boy was it painful afterwards. But it did heal and second time around, with more experience and more importantly no epidural and a good birthing position, I was able to deliver without any more than a small tear which I didn't even feel afterwards (well, barely, not enough to want pain relief). So it is certainly possible to not need one, and it is also ok to tear naturally after a prior epi. GL, I hope things go better for you this time around.