EPI NO.

Hi,

My ob has recommended that I consider using the 'EPI NO' prior to giving birth as it apparently reduces the chance of tearing or the need for an episotomy.

Just wondering if anybody had heard of or used the 'EPI NO' before?

CJ.

I've just checked out the website and the video - it looks interesting. I've just sent the video to my DH - I want to see his eyes pop out of his head!

Hi Claire,
I used it before the birth of DS. I figured I had nothing to lose.
I didn't tear or need an episotomy.
I'm not sure if it is because of the Epi-no but if nothing else I think it gave me more confidence. I will use it again this time too.

I just looked at that too. I think its a great idea. Do you know how much they cost and where to get one from??

I bought mine from the epi-no online website. I've never seen them anywhere else. They aren't cheap either. $179 including postage
I figured if I got to use it for a couple of bubs and ended up with no tears it was worth it.

Also, I'm not sure if it is related, but the midwives commented on how well I did during the pushing stage. (something else you learn through using the epi-no) It was less than 20 minutes and they were holding me back a bit waiting for my Ob to arrive. He ran in the door, straight into a gown and was just in time to deliver the body as the head was already out.

Thanks for that feedback Mel. It sounds like it was a positive experience! Just wondering, how big was your baby?

He was 3.1kg - so not huge. Head circ - 34cm

Wow, that sounds like something I'd be really interested in. I think I'll talk to DH about it tonight.

Thanks Mel for your feedback. And BTW, I'm a Mel and DH is a Craig too :)

Hi,

I figure that even if I use it and still end up either tearing or needing and episotomy, at least I'll know I've done everything I can to prevent it.

CJ.

Kar, I know you can't post the link directly on here. But where was it that you saw the video on the Epi No. Very curious, that's all.

Trish, the video sparked my curiosity as well so i googled epi-no and went to the the relevant website then go to 'resources' and it says EPI-NO movie clip. :)

OK found it now, thanks for that :)

There is also a 2006 Cochrane Review about the benefits of perinatal massage.

Interestingly it says that perinatal massage either by hand or with a machine makes a significant difference to chance of having tear sutured in women giving birth the first time. It says that the results are better for women who massage on average 1.5 times a week but NOT for women who massage more frequently.

They couldn't find any difference between using machines or hands. But they also said no one has ever run a test comparison between machine and hand.

It doesn't seem to make any difference to whether you tear or not, or have an episiotomy, just whether you get stitched. I don't quite get that but anyway....

here's the abstract and an extract for those of you who don't want to get the article from the cochrane review database.

:

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Beckmann MM, Garrett AJ. Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews 2006.

Background
Perineal trauma following vaginal birth can be associated with significant short- and long-term morbidity. Antenatal perineal massage has been proposed as one method of decreasing the incidence of perineal trauma.

Objectives
To assess the effect of antenatal perineal massage on the incidence of perineal trauma at birth and subsequent morbidity.

Main results
Three trials (2434 women) comparing digital perineal massage with control were included. All were of good quality. Antenatal perineal massage was associated with an overall reduction in the incidence of trauma requiring suturing (three trials, 2417 women, relative risk (RR) 0.91 (95% confidence interval (CI) 0.86 to 0.96), number needed to treat (NNT) 16 (10 to 39)). This reduction was statistically significant for women without previous vaginal birth only (three trials, 1925 women, RR 0.90 (95% CI 0.84 to 0.96), NNT 14 (9 to 35)). Women who practised perineal massage were less likely to have an episiotomy (three trials, 2417 women, RR 0.85 (95% CI 0.75 to 0.97), NNT 23 (13 to 111)). Again this reduction was statistically significant for women without previous vaginal birth only (three trials, 1925 women, RR 0.85 (95% CI 0.74 to 0.97), NNT 20 (11 to 110)). No differences were seen in the incidence of 1st or 2nd degree perineal tears or 3rd/4th degree perineal trauma. Only women who have previously birthed vaginally reported a statistically significant reduction in the incidence of pain at threemonths postpartum (one trial, 376 women, RR 0.68 (95%CI 0.50 to 0.91) NNT 13 (7 to 60)). No significant differences were observed in the incidence of instrumental deliveries, sexual satisfaction, or incontinence of urine, faeces or flatus for any women who practised perineal massage compared with those who did not massage.

Authors’ conclusions
Antenatal perineal massage reduces the likelihood of perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain and is generally well accepted by women. As such, women should be made aware of the likely benefit of perineal massage and provided with information on how to massage.

In the article itself it says:

(A) Perineal trauma requiring suturing
Perineal massage was associatedwith an overall 9%reduction in the incidence of trauma requiring suturing (three trials, 2417 women, relative risk (RR) 0.91 (95% confidence interval (CI) 0.86 to 0.96), number needed to treat (NNT) 16 (10 to 39)). This reduction was statistically significant for women without previous vaginal birth only (three trials, 1925 women, RR 0.90 (95% CI 0.84 to 0.96), NNT 14 (9 to 35)). Subgroup analysis revealed
that women who massaged up to an average of 1.5 times per week experienced a 17% reduction (two trials, 1500 women, RR 0.83 (95% CI 0.75 to 0.92), NNT 9 (6 to 18)), women who massaged an average of 1.5 to 3.4 times perweek experienced a 8%reduction (two trials, 1650 women, RR 0.92 (95% CI 0.85 to 1.00), NNT 22 (10 to 208)), while women who massage more than 3.5 times per week did not experience a statistically significant reduction in the incidence of trauma requiring suturing (two trials, 1598 women, RR 0.93 (95% CI 0.86 to 1.02)).

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The only suggestion and food for thought so to speak is that although it has been proven to reduce your chances of tearing it can also do damage to your pelvic floor muscles because your pelvic floor muscles to loose some of its strength and flexibility as it is not designed to be stretched for time periods over a several week period. This could lead to urinary incontence later on. This is from the research I did for my midwifery course. The other issue is that if a woman is going to tear she is going to tear. Just giving you some information and please do with it as you wish.

Nurse Dan - the epi-no is marketed as a pelvic floor trainer too. Would this make a difference??? I would like to use it for the perineal tearing aspect but I was also looking at it from the pelvic floor training point of view. Did your research look into the the mechanical versions or the digital version?? I would really like to know more so I can make an informed choice.

I'm in the middle of packing to move but let me see if I can track down my research.

Thank you!! I am just a nosy nurse too :D Have to know the ins and outs of a ducks bottom and make an informed decision. Take your time though.

Hi Michelle, I haven't done any research into the EPI-NO, but one of the girls i've worked with sustained a very nasty tear during the birth of her son and consequently had some pelvic floor weakness. She bought the EPI-NO as a pelvic floor trainer and it as done wonders for her. She has brilliant control now and will recommend the EPI-NO to anyone and everyone :)

Thanks Chelleg. It is good to hear feedback on the pelvic floor part of it. It is an expensive tool for a few weeks for perineal stretching but if it helps with pelvic floor strength (my biggest fear really) then it might be something to invest in.

Hi everyone,

I bought the epi-no b4 i had DS, and although i maintain that i used it according to their directions (it said basically, i forget the wording now, but "inflate and push out" kind of thing..they say thats not what you are supposed to do), i didn't over-inflate it (says to go up gradually), and pushed it out and then 5 mins later started bleeding. My obs said basically i gave myself an internal tear. As i was about 2 weeks before my EDD i didn't use it again, as i wanted to give myself as much time to heal b4 the birth so i could avoid tearing then.

Anyway, they said i didn't use it properally (maybe they were afraid i would sue??), i said i did, but my advice is just to do it very slowly (it didn't even hurt pushing it out), to avoid this.

I can't tell you whether it works to avoid tearing, but i am still planning on using it b4 my next birth, and when i get off my backside, am planning on using it for pelvic floor strengthening which i desperately need... I already have a slight prolapse, and leak every time i sneeze :eek:

Anyway, not trying to put people off it, but just letting people know what problems i had so they can avoid them.

I got the one with the pressue guage you can read, and except for the bleeding thing, was quite happy with it.

In the end i had the vacuum, so did have 2x 1st degree tears (which although for my whole pregnancy was my worst fear, that an an episiotomy), it wasn't so bad, so even if you do tear a little bit, you really don't have to be upset & dissapointed...

Good luck with your decision.

Yael

What is an EpiNo

Google it to get the website - it will explain better than I can. Simply, it is a device to assist in perineal stretching prior to delivery but it also has uses for assiting and assessing pelvic floor strength.

There are pros and cons for its use.

I used the EpiNo, but only got to 7cm with it.. since DS came nearly 3 weeks early :)

I never pushed it out, but it took effort to keep it in there coz my body was trying to push it out on its own! lol. I don't recall it saying to push it out?

Anyway, I only seemed to increase by 1/2cm every couple of days, so it was very gradual for me. But, I didn't tear during labour, and the dr & midwife were pleased with my 2nd stage, saying I did really well (but then they might tell everyone that LOL).

I recommend it, and I think it gave me some confidence that yes it CAN stretch enuf for a baby, even tho I didnt' get up to the full 10cm. hehe. I just felt that I wouldn't be able to do the hand massage properly, so opted for the mechanical.

I've had no probs with pelvic floor, and have never used the epino for it either. In fact I was very slack all round with pelvic floor... the midwives everyday after the birth said am I doing the exercises, and I lied and said yes. LOL.