One of the most common concerns of pregnant women is the thought of tearing during birth.

If you’re like most pregnant women, you may think you would do anything to avoid trauma to that area of your body.

You might have heard about a device called the Epi-No, which claims to reduce the risk of tears and trauma to the pelvic floor.

Does The Epi-No Reduce Vaginal Trauma?

Many women swear by the device, while others aren’t convinced it’s worth the financial outlay.

The health professional world is also divided on the effectiveness of this device. Find out what it is and how it works.

What Is The Epi-No?

The Epi-No was invented by a German obstetrician in the early 1990s. Working with a team of physiotherapists, midwives and doctors, he developed a device which could be used to prepare the perineal area for childbirth.

The perineum is the area of tissue between the vagina and anus. During labour, the perineum stretches to accommodate the passage of the baby’s head (the largest part of the baby).

The Epi-No is an inflatable balloon, attached to a hand-operated pump with a pressure display – similar to a blood pressure pump.

This device is advertised as a childbirth and pelvic floor trainer, and is used during late pregnancy to allow women to connect with their pelvic floor.

This is said to lower the risk of perineal tearing, and complications from this trauma, and to reduce the need for episiotomy. It also claims to improve sexual function after birth.

How Does The Epi-No Work?

The Epi-No is designed to be used from 36 weeks gestation. Women are instructed to insert the balloon into the vagina, and to inflate it until they feel some pressure, but not pain.

Then they contract and relax the muscles of their pelvic floor, to expel the inflated balloon gently. This simulates the action of the muscles during birth.

Women generally use the device once or twice daily, for around 15 minutes each time. They can gradually increase the size of the balloon, so the perineal area becomes used to being contracted and released, and familiar with the stretching sensation that occurs when the baby’s head is crowning.

What Are The Benefits Of The Epi-No?

Supporters of the Epi-No suggest the device reduces the risk of tearing and the need for episiotomy, and that it improves recovery outcomes following birth.

There is no research data to support these claims. A recent study looked at outcomes after birth, in women who had an uncomplicated pregnancy. It found no evidence that Epi-No prevented pelvic floor trauma.

At the same time, there appear to be no negative effects from using the Epi-No. It could be helpful for women who have strong negative emotions surrounding the second stage of labour.

Using the device for preparation for giving birth might help them to overcome their fear and be more relaxed during labour.

Some women experience a lot of fear associated with pushing and crowning during birth.

They find the device helps them to identify and connect with the sensations of pressure and stretching which occur during the second stage. These women often report less anxiety and more confidence about their birth.

The Epi-No device could be useful for women with pelvic pain syndrome, or pelvic floor muscle over-activity. With the guidance of a pelvic floor physiotherapist, they could use the device to learn how to relax the pelvic floor, as they work on the emotional and physical responses to the stretching and pressure sensations.

What Are The Risks Of The Epi-No?

The research doesn’t indicate any risks in using the Epi-No device, when it is used correctly.

However, many health professionals question the use of the device during pregnancy, if there is no disorder or extreme fear.

The perineum is designed to stretch, and during labour the influence of birthing hormones helps women to breathe and move to allow the safe descent of their babies.

The Epi-No could send a negative message to women, undermining their innate faith and trust in their bodies. Relying on a device to ‘teach’ the perineum to stretch has the potential to interfere with the normal process of labour.

What Is The Alternative?

The Epi-No might have some benefits for women who have extreme fear of the labour process. For most women, being informed about labour will help them to trust their bodies.

The birth environment and care provider you choose will have an impact on how your labour will unfold. Find out more about Undisturbed Labour – What It Is And Why Aim For One? here.

Being upright and active (not lying down or restricted in movement) will allow your body to open and stretch the way it is designed to do.

Being in positive and active positions during labour gives you a sense of control, and can help you to avoid perineal trauma. Read more about the benefits of active birth for mothers and babies.

Work with your body during pushing. Breathing your baby out, or moving into positions to slow things down, can give your perineum plenty of time to stretch and open. Directed or purple pushing is best avoided.

Other tips to help you feel more confident during the second stage:

Warm water – either in a birth pool or in warm compresses held to the perineum – can help the tissues to soften, and provide relief
Hands and knees position, or side lying, can reduce the chances of tearing
Allow the baby’s head to descend slowly, rather than bear down forcefully (unless there is a medical emergency requiring your baby to be born quickly).
Find out about perineal massage, which has been shown to reduce the risk of tearing.

Episiotomies were once performed routinely, in the belief they prevented pelvic floor damage. Research has shown this to be untrue. Cutting the perineum should only be done in medical emergencies. Remember, a tear heals quicker and causes less long-term damage than a surgical cut. You can find tips to avoid an episiotomy here.

Using the Epi-No device is a controversial topic. Some women love it and others hate it. The cost itself is a big factor working against it, especially as there is no evidence the device does prevent perineal trauma. Women who have pelvic floor pain or disorders might benefit from using the device, with the guidance of a qualified pelvic floor physiotherapist.

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