I’ve had a few queries about the efficacy of perineal trainers (specifically the EPI-NO) in reducing birth trauma to your lady bits.
This post ain’t for you if:
- You’re squeamish about medical stuff;
- If the thought of someone pushing out a watermelon through an opening the size of a lemon freaks you out;
- If you’re that husband/ boyfriend/ partner who plans to stay away from the ‘business end’ in labour;
- If the words ‘episiotomy’ and ‘perineal trauma’ make you feel ill.
Consider yourself warned!
If you’re interested, please check out the official EPI-NO website.
I love the leading line… “German innovation is making a natural childbirth easier…” GERMAN INNOVATION MAKES EVERYTHING BETTER – EVEN YOUR VAGINA!
Anyway, there are less than 10 EPI-NO specific studies out there… I thought it would easier to summarise them in a table…
|2001||Germany||Effectiveness of EPI-NO in avoiding episiotomies and improving foetal outcome||Comparison of EPI-NO group (50 pregnant women) against group not using EPI-NO||EPI-NO group had: reduced episiotomies, less perineal tears (2 vs 4%), less analgesia required, better one-minute APGAR scores||Birth training with EPI-NO significantly decreases the rate of episiotomies in primiparous|
|2004||Singapore||To study the use, safety and effectiveness of EPI-NO in primiparous women||Comparison of EPI-NO group (31 pregnant women, primiparous, prospective) vs not using EPI-NO group (60 pregnant women, primiparous, retrospective)||EPI-NO group had: lower perineal trauma rate (90 vs 97%, not significant). EPI-NO was well tolerated, no lacerations or infection resulting from its usage; one case of minimal bleeding post-usage||EPI-NO is safe and acceptable to users. EPI-NO reduced episiotomy rates. Overall perineal trauma rate was slightly (but not significantly) lower in the EPI-NO group|
|2004||Australia||Pilot study of the first use of the EPI-NO birth training device in Australia for women having their first baby||Comparison of EPI-NO group (48 primigravidae) vs not using EPI-NO group (matched for ?)||EPI-NO group had: improved outcome for the perineum compared with the non-user group||The EPI-NO device should be offered as an option to all primigravidae to use during the late third trimester|
|2009||Germany||To verify the preliminary results with EPI-NO in a prospective randomised trial||Randomised, single-blind multicentre trial in four university hospitals in Germany including 276 primigravidae||EPI-NO group had: significant increase in the incidence of intact perineum (37 vs 26%) and a tendency towards lower episiotomy rates (42 vs 51%). No significant differences between the two groups regarding incidence of perineal tears, duration of second stage of labour, use of pain relief and rate of vaginal infection||Training with EPI-NO increases significantly the likelihood of having an intact perineum and reduces the episiotomy rate|
|2011||Australia||Whether antepartum use of the EPI-NO may reduce levator trauma||200 nulliparous women were examined with four-dimensional translabial ultrasonography at 35-37 weeks of gestation and 3 months postpartum in a randomised controlled pilot study||The EPI-NO group had: a non-significant 42% and 30% reduction in levator avulsion and microtrauma||There is a non-significant lower incidence of pelvic floor muscle injury in women who used the EPI-NO device from 37 weeks onwards|
|2014||Brazil||How tolerable is the EPI-NO as a perineal distensibility technique||227 full-term pregnant women were asked about their sensation of discomfort (measured on the Visual Analogue Scale)||The greater the perineal distensibility on the EPI-NO, the lower the pain reported by the patients||The assessment of perineal distensibility with EPI-NO was well tolerated by the pregnant women|
|2014||Brazil||Comparison of perineal distensibility between women with twin and singleton pregnancies||Prospective cross-sectional case-control study with 20 twin and 23 singleton pregnancies.||The greater a pregnant woman’s abdominal circumference, the greater the perineal distensibility, regardless of whether the pregnancy is twin or singleton|
The final study doesn’t relate to EPI-NO but the findings are interesting all the same…
- Overall there is evidence that EPI-NO is useful in reducing rate of episiotomy, perineal tears, trauma to pelvic floor muscles, and pain levels during delivery;
- Quality of study design is variable; some results are significant, some not significant (but remember this doesn’t mean that the findings aren’t useful; significance could change with tweaks in study design);
- Certainly there are no complications associated with use of the EPI-NO; from the studies there was one case of mild bleeding post usage, no biggie;
- The price tag in Australia is in the region of AUD 200 so if you can afford this, and you are motivated to use it correctly, then certainly no harm (and most likely some good) would come from using it;
- One thing the studies don’t mention is that the EPI-NO is also recommended for use after delivery to get your bits back into shape. Surely not a bad thing.
Please share your feedback and comments – has anyone used this? Love it? Hate it? Don’t want to discuss it because it’s your punani? It’s OK… you can share with Dr Nat… 🙂
(Don’t want to judge, but if I had the surname of the 2nd author, final reference, I would consider changing it…)
Hillebrenner J, Wagenpfeil S, Schuchardt R, Schelling M, Schneider KT. Initial experiences with primiparous women using a new kind of EPI-NO labor trainer. Z Geburtshilfe Neonatol. 2001 Jan-Feb;205(1):12-9.
Kok J, Tan KH, Koh S, Cheng PS, Lim WY, Yew ML, Yeo GS. Antenatal use of a novel vaginal birth training device by term primiparous women in Singapore. Singapore Med J. 2004 Jul;45(7):318-23.
Kovacs GT, Heath P, Heather C. First Australian trial of the birth-training device EPI-NO: a highly significantly increased chance of an intact perineum. Aust N Z J Obstet Gynaecol. 2004 Aug;44(4):347-8.
Ruckhäberle E, Jundt K, Bäuerle M, Brisch KH, Ulm K, Dannecker C, Schneider KT. Prospective randomised multicentre trial with the birth trainer EPI-NO for the prevention of perineal trauma. Aust N Z J Obstet Gynaecol. 2009 Oct;49(5):478-83.
Shek KL, Chantarasorn V, Langer S, Phipps H, Dietz HP. Does the EPI-NO Birth Trainer reduce levator trauma? A randomised controlled trial. Int Urogynecol J. 2011 Dec;22(12):1521-8.
Nakamura MU, Sass N, Elito Júnior J, Petricelli CD, Alexandre SM, Araujo Júnior E, Zanetti MR. Parturient perineal distensibility tolerance assessed by EPI-NO: an observational study. Einstein (Sao Paulo). 2014 Jan-Mar;12(1):22-6.
Kubotani JS, Moron AF, Araujo Júnior E, Zanetti MR, Soares VC, Elito Júnior J. Perineal Distensibility Using EPI-NO in Twin Pregnancies: Comparative Study with Singleton Pregnancies. ISRN Obstet Gynecol. 2014 Mar 27;2014:124206.