Perineal preparation is a big topic in every antenatal class. And the Epi No device has been discussed for many years for perineal preparation.

What is the idea behind the Epi-No device?

The Epi-No device was developed by a German gynecologist in the 1970s who observed women in Africa preparing their perineums with calabash gourds of different sizes. He was impressed by how this preparation reduced injuries during pregnancy or how the severity was less severe. Preparing the perineum for the birth of the baby’s head by stretching it during pregnancy. That’s what it’s mainly about. But also to train the perineum against the resistance of the balloon, to strengthen it and at the same time to lengthen the muscle fibers elastically to the unusually strong stretching in the size of the head. I still find it very convincing that all this is possible at the same time with such a simple device. However, this article is in no way intended to promote Epi-No. For some years now there has been a competing product that works on exactly the same principle and is therefore just as recommendable. The name of this vaginal trainer is “Aniball”. It is more due to my sense of loyalty and respect for the idea that I mention the original more often. The competitor’s product is a little cheaper. (But if they had asked me when choosing the name, I would definitely have advised against “Aniball”).

Implementation

No matter which device you use, the balloon is “the pumpkin”. Insert it halfway into the vagina, close the valve and inflate the balloon a little until you feel it stretch. Do not overdo it! Lubricant is needed for insertion! Oil is not enough. You train and strengthen your muscles by gently squeezing the balloon with your pelvic floor muscles. A well-trained pelvic floor heals and recovers better after the birth. It is also much easier for women to do pelvic floor training after giving birth if they are familiar with working with the pelvic floor. There is also no need to worry that a little pelvic floor training will turn the pelvic floor into an insurmountable obstacle for the baby. I hear this concern again and again. It’s really unfounded.

Breathing with the Epi-No

I recommend the following breathing when training with the Epi-No: Inhale through your nose, squeezing the balloon lightly with your pelvic floor muscles and mentally counting to 4. Exhale through the mouth, audibly on “sh”, “pffff” “aaaa” or another sound, relax the pelvic floor muscles. Do not squeeze the balloon, but allow the balloon to stretch the tissue. After 10 minutes, let the balloon slide out of your vagina. This simulates the birth of the baby’s head. As the balloon is slightly conical in shape, it stretches the perineum a little more as it slides out.

Irritated?

If the breathing described irritates you: very good! Then you probably do Pilates or play the tuba or are otherwise familiar with diaphragmatic breathing. Normally, the exhalation is used to describe the tensing of the pelvic floor and abdominal muscles. And with inhalation, it is recommended to relax the pelvic floor as well as the abdominal wall, which pushes the abdominal organs downwards and forwards due to the pressure of the diaphragm. In birth preparation, however, it is exceptionally the other way around. Why? Because as a midwife I think it’s important that you prepare for the head birth. And this is about relaxing the pelvic floor with your exhalation, giving the baby all the space it needs, letting go and pushing along with the required strength of your abdominal muscles. That’s why. In my postnatal course, we practise this over and over again the right way round. But in the Pregnancy yoga and in the Birth preparation course just like that: Exhale= ready to let go for the little head.

When to start training?

As training with the EpiNo device stretches the perineum more than massage, you should only start using the EpiNo from 3 weeks before your due date. From 37+0 weeks’ gestation, ideally every day and for 10-15 minutes. You will find that you can inflate the balloon a little more each day. The balloon does not really have to reach the size of the baby’s head. But each time you do this, the difference that your body will have to make on the day of birth will be reduced. Perineal and vaginal tears during childbirth are less common. But of course this is no guarantee! It’s just a shift in the probabilities. I recommend taking a hay flower bath beforehand, as with the perineal massage.

My personal experience with the Epi-No

As a midwife, perineal massage was originally closer to my heart than the Epi-No device. I started with perineal massage 5 weeks before the birth. However, I didn’t get on well with it at all. It was very uncomfortable for me and I couldn’t bring myself to do it regularly. From 37+0 weeks’ gestation, I then started exercising with the Epi-No for 10-15 minutes a day. And that was much more my method. I found it very impressive how quickly my perineum became more elastic. And I used and enjoyed the daily half hour (including the hay flower bath) to prepare myself mentally for the birth. I did the breathing described above, I thought about what I wanted to think about during the birth, I practised letting go of my pelvic floor muscles… This kind of engagement with my body and mental work helped me to grow in confidence and trust. My son was born one day after his due date. Although the birth had to be ended with a suction cup, my perineum remained intact. This personal experience is part of why I recommend the concept of Epi-No and Aniball. But of course you don’t have to do that!

Critical voices

Of course, there are not only positive voices when you consult the Internet on the subject of Epi-No. First of all, the price of these devices is not exactly positive. Around CHF 80 seems quite expensive for such a little balloon. You definitely don’t need the more expensive version with the pressure indicator. The company also offers to use the device to strengthen the perineum after the birth. As great as I think the idea is beforehand , I think it’s a stone age idea for strengthening in the postpartum period. There are so many better tools, which I would be happy to report on separately. If you google it, you’ll find a few reviews that really don’t convince me: people often argue against training with the Epi-No because the hormonal situation is different during childbirth than during pregnancy. And that the body is naturally made for giving birth. I agree with both. Nevertheless, my experience of over 20 years in obstetrics, preparation and recovery is that the perineum is injured much more frequently and to a greater extent when unprepared. Even hormones do not reliably protect against this during childbirth. Before any sporting challenge, you train your body, stretch your muscles and slowly prepare your body for it. That’s exactly how I understand the Epi-No. I am much more convinced by slowly stretching the pelvic floor and only giving it a small increase during childbirth. It seems more logical to me to stretch the muscles slowly over 3-4 weeks and reduce the likelihood of major injuries. I also don’t share the concern that you can overstretch the pelvic floor if you use the device as described. I have heard of women who have torn their perineum during pregnancy, but this is more down to the user than the method.

Is the Epi-No a guarantee against a perineal tear?

No, by no means! But it does significantly reduce the likelihood of a perineal tear or episiotomy! However, it is of course possible that your child’s heartbeat is stressed, so that you want to speed up the birth in the end and perform an episiotomy or that you have to end the birth with a caesarean section. That’s the way it is with childbirth: you prepare yourself really well, but you always have to remain open to the possibility that things might turn out differently in the end.  

3 Instagram tips

I have just posted an Instagram reel. In the brevity of the format, I have decided on the 3 tips that I often find missing: Tip 1: don’t forget the lubricant! Otherwise it may be very uncomfortable on the vaginal mucosa. Tip 2: you have to hold the Epi-No with one hand and prevent it from slipping out when you inflate it. The fact that it wants to slip out is completely normal and is due to its shape. You’re not doing anything wrong. Tip 3: In addition to physical preparation, make sure you also prepare mentally! It would be a shame not to use the time for this. Focus on your safe space, recite your affirmations and “anchor” this with your triggers such as music, scent, etc. We will discuss all of this in the course. Looking forward to seeing you!