Written By: Zeinab Uddin
For decades, the episiotomy - a surgical cut made at the perineum during birth - was presented as a "necessary" part of childbirth, especially for first-time mothers. What many don't realize is that this practice began not out of medical necessity, but as a marketing ploy to make the use of forceps more convenient.
Today, research and global health authorities like ACOG, the World Health Organization (WHO), and the Royal College of Obstetricians and Gynaecologists (RCOG) have made it clear: routine episiotomies are outdated and not recommended. Studies show they do not prevent severe tears - in fact, they often lead to worse outcomes, such as increased pain, slower healing, and greater risk of complications. They are now recommended only in rare cases of emergency, when immediate delivery is necessary.
Natural tears, when they occur, tend to follow the body's own design.
A natural tear occurs between cells, allowing them to heal more easily and with less scarring.
An episiotomy, on the other hand, cuts through those cells in a straight line, and when stitched, they can't align properly again. Healing is often longer and more uncomfortable.
Here's what different types of tears look like:
1st degree: Skin tear - often heals on its own without stitches.
2nd degree: Muscle tear - requires sutures (stitches).
3rd degree: Extends into the rectal tissue.
4th degree: Reaches the anal sphincter.
It’s worth noting that every episiotomy is at least a 2nd-degree tear, and because the tissue is already cut, it can easily extend into a 3rd or 4th-degree tear with the pressure of birth.
Contrary to common belief, not every first-time mother will tear - especially when she's supported in upright, physiologic positions and not rushed.
Birth is designed to work. The perineum is designed to stretch.
It's truly astonishing that despite so much evidence against routine episiotomies, they're still widely performed in some regions. But knowledge is power - when women understand how their bodies work, they can make informed choices that protect their wellbeing.
Allah created the body with wisdom and purpose. Trust that design, prepare well, and remember: healing is most beautiful when it follows the path He intended.
Very well written!! Lack of preparation and stressful hospital environment leads to many unnecessary interventions including episiotomy. The onus lies on the mother to be prepared and be her own advocate
Well written masya Allah, thankyou for spreading the truth
SubhanAllah this reminded me of my own birth. I did not get an episiotomy, but did tear. And I wonder if I had not been in the lithotomy position would I have not torn? I cannot go back and change anything. What I can do is she is better positions that are more beneficial for my body and help other women become aware that other positions are also an option.
[Allah is] the One who perfected everything which He created.”
— Surah As-Sajdah (32:7)
These ayāt remind us that the human body, especially in something as profound as birth is not flawed or lacking. Interventions have their place, but trusting the natural process and being informed about our choices is part of honoring that divine design.
Clearly understood about natural tearing and episiotomy.. Well written. Thank you.
Very important topic and well explanation done on the natural tear and episiotomy. The mother need to know the difference between them and to be prepared for avoiding episiotomy