Neither, I did perineal massage. No tears no stitches. If you give the head time to crown while your midwife or ob gently irons out the perineum you'll greatly reduce the odds of tearing at delivery. Current research shows most episiotomies are unnecessary and drastically increase you chances of getting a serious tear anyway.
If you need a nonemergency episiotomy, you can get a local or if you get an epidural, you should be mostly numb.
Whether or not you "choose" medication for pain relief during labor and delivery is entirely up to you and medication is totally optional.
Hypnobirthing and the Bradley method along with access to a birthing ball, bathtub, and the ability to move around, and change positions in labor and delivery can help make the experience bearable. Taking a bradley or hypnobirthing class will do wonders to reduce anxiety about what to expect in labor and delivery.
For medication there are narcotics to temporarily take the edge off, spinal anesthesia, epidurals and walking epidurals, each hospital or birthing center has it's own set of medication offerings, and you'll need to talk to your midwife/ob to find out what to expect. You should find out when medication is available, what is available, and realistically what type of relief you can expect. Not all options will provide total relief but can give you a break if you're exhausted or need help relaxing to continue.
I did both my labors using the bradley method and one in a hospital and one in a birthing center. I had no medications or interventions and didn't need any stitches, in both cases I felt well enough to go home the same day I had the baby.
It's not all doom and gloom and scary. Sometimes you really can have a textbook experience where everything just goes ok. It's hard work, don't let anyone tell you otherwise, but the more you learn about your choices having a baby, the less anxious you should feel. Try to watch something more than just A Baby Story :-) Lots of those are pretty tense.