Pion interactions in the nuclear medium are studied using renormalizable relativistic quantum field theories. Previous studies using pseudoscalar πN coupling encountered difficulties due to the large strength of the π NN vertex. We therefore formulate renormalizable field theories with pseudovector πN coupling using techniques introduced by Weinberg and Schwinger. Calculations are performed for two specific models: the scalar-vector theory of Walecka, extended to include π and ρ mesons in a non-chiral fashion, and the linear σ-model with an additional neutral vector meson. Both models qualitatively reproduce low-energy πN phenomenology and lead to nuclear matter saturation in the relativistic Hartree formalism, which includes baryon vacuum fluctuations. The pion propagator is evaluated in the onenucleon-loop approximation, which corresponds to a relativistic random-phase approximation built on the Hartree ground state. Virtual N N loops are included, and suitable renormalization techniques are illustrated. The local-density approximation is used to compare the threshold pion self-energy to the s-wave pion-nucleus optical potential. In the non-chiral model, s-wave pion-nucleus scattering is too large in both pseudoscalar and pseudovector calculations, indicating that additional constraints must be imposed on the lagrangian. In the chiral model, the threshold self-energy vanishes automatically in the pseudovector case, but does so for pseudoscalar coupling only if the baryon effective mass is chosen self-consistently. Since extrapolation from free space to nuclear density can lead to large effects, pion propagation in the medium can determine which πN coupling is more suitable for the relativistic nuclear many-body problem. Conversely, pion interactions constrain the model lagrangian and the nuclear matter equation of state. An approximately chiral model with pseudovector coupling is favored. The techniques developed here allow for a consistent treatment of these models using renormalizable relativistic quantum field theores.