First baby, born at 36 weeks, 3.1 kilos (6.82 pounds) epidural, no tears, no stitches.
Second baby born 23 minutes past midnight of her due date 3.7 kilos (8.14 pounds)no epidural, no tears, no stitches.
I was 6 ish pounds, my husband was nearly 10 pounds- he was a third baby though, I was a first.
Definately go tear rather than cut- i've done extensive research, and everything I read, or was told was all for tear.
A tear is less painful because the skin is as stretched as it can be before you'll tear- once you've stretched out the area, the nerves are almost completely desensitised, you'll just feel a bit of a burning sensation while the baby crowns- usually, they'll have to tell you whether you've torn or not- you wont know. A cut they'll have to do before you are completely stretched out- you'll probably feel it-although maybe they can numb you if there's time.
A tear will also heal better, and quicker, due to the uneven edges- a straight cut has two smooth edges, and takes longer to fuse together, so theres also a higher risk of infections.
A small tear might not need stitches. A cut will.
You need to make sure you take your time delivering your babies head- that is the key. Let things stretch, take a few minutes, catch your breath before giving that final push. Everyone will be very excited about seeing the head crown, but just you take your time.
My poor mother needed stitches with all three of us kids. My youngest sister was more than 9 pounds, and was not in a good birthing position- they told my mum to push anyways, even though she was feeling like she shouldn't yet. She had 27 stitches, 18 internal, 9 external.
She is still bitter about being made to feel like she should ignore her own body, and just do what she was told.
You can refuse an episiotomy. They can't force you, unless they need to get the baby out with forceps or vacuum (in that situation-go vacuum over forceps- if they say forseps, ask for vacuum first)
it's good to have a loose plan, but birth has a way of not co-operating (my waters broke unexpectedly at 36 weeks. Labour didn't start, so I had to be induced, so I needed the epidural- never saw that comming, choises unexpedetly being taken completely out of my hands)
what you need, rather than a bith plan, is information about your options-should you be in a position to make choices. Don't obsess over it, it's going to be one of those things that you just have to take as it comes.
In the end- who cares whether they had to pull the baby out through your ear, as long as the two of you are ok.;)