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(WHO), and the Royal College of Obstetricians and Gynaecologists (RCOG) have made it clear: routine episiotomies are outdated and not recommended.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.