EPI-NO: Preparing the Perineum
By Kim Vopni
For centuries, women have given birth and different cultures have used creative methods to help lessen the discomfort, optimize labour and improve postpartum outcomes. In Africa, for instance, women use gourds of increasing size to help prepare the perineum for birth in order to reduce the likelihood of tearing. This seemingly archaic practice was actually the inspiration for a modern day device called the EPI-NO that helps prepare the mind and body for childbirth.
The EPI-NO (short for No Episiotomy) was designed by a German physician who was inspired to make this African practice more mainstream. He worked with a team of physiotherapists, midwives and doctors to develop the product which has been sold worldwide since 1992.
The EPI-NO is a biofeedback tool that allows you to connect with your pelvic floor - a part of your body that you have probably not give much thought to. Used during pregnancy, you learn how to contract your pelvic floor muscles and more importantly, how to relax them. Then in the last 3 weeks of pregnancy you add an additional element of training called perineal massage that gently prepares the perineum for the stretch it will endure during birth and teaches you to yield against that discomfort so you are less likely to tense up on the big day.
The perineum is the area of skin between the vagina and the anus and it is an area worth protecting! It will face tremendous pressure and stretch during childbirth that can unfortunately contribute to pelvic floor dysfunction such as incontinence and prolapse. Preparing the perineum prior to childbirth can help prevent tearing or requiring an episiotomy.
If you are not familiar with the term, an episiotomy is an incision made in the perineal area either towards the anus or on an angle. The thinking behind this procedure was that it enlarges the space for the baby’s head to pass through however, episiotomies can increase the likelihood of a 3rd of 4th degree tear, and lead to complications such as longer healing time, painful intercourse post partum, and pelvic floor dysfunction. Thankfully episiotomies are not performed as often as they used to be but it is a good idea to talk to your birth professional and ask them if this is something they do and how they work to support your pelvic floor during delivery.
The pelvic floor is a small group of muscles and connective tissue that run from the pubic bone to the tailbone and function to support the internal organs, ensure healthy elimination and contribute to a strong core. Pelvic health is a very neglected topic in childbirth preparation classes and health care visits so unfortunately many women don’t know about these muscles until it is too late. By getting to know your pelvic floor prior to childbirth, you will be ready when it comes time to push your baby out and will be better able to prevent unnecessary pain and dysfunction.
Birth is a very physical event and like other physical activities, you need to train your body ideally with the fitness principle of specificity which suggests you train with movements or activities that most closely mimic the event you are training for. While you can’t give birth over and over during your training, you can choose appropriate exercise that prepares you for labour and birth. The EPI-NO is like a pelvic floor personal trainer that builds strong, flexible muscles that are able to support the weight of the growing baby, that are able to relax to allow the passage of the baby’s head during birth and that are able to recover more optimally postpartum. The EPI-NO also allows you to learn how to yield against the discomfort you may feel as the baby’s head crowns during birth. How’s that for specificity!
Users report a reduction in anxiety and more confidence about the birth. Studies have shown that users of the EPI-NO vs non-users have shorter pushing times, higher apgar scores and a higher rate of intact perineum. Birth position, having a midwife and a doula and mind body work also optimize normal physiologic birth and increase the chances of having an intact perineum and avoiding an episiotomy.
By Kim Vopni, Certified Fitness Trainer and Pre/Post Natal Fitness Consultant
Author of Prepare to Push