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EPI-NO for avoiding perineal trauma

My goodness, we seem to be selling a lot of EPI-NOs these days! There must be some information about them in the Parents magazines that has generated the enquiries, and women seem to be keen on using them to prepare for birth (although they also have a role post birth as a perineal muscle exerciser). One obstetrician did call me recently to request some pamphlets about it that he could hand to his clients.

Women’s bodies are designed to stretch well during birth and if the second stage of labour is not rushed so that tissues have time to stretch naturally, and there is sensitive management (read: no handling) of the perineum as the baby emerges, there should be minimal, if any damage to the vaginal tissues. Midwives know that women value an intact perineum and most midwives try hard to maintain the integrity of muscles and skin around the vaginal opening.

Not all doctors have understood women’s sensitivity towards stitches and many lack the skills and patience to stand back an allow the baby to emerge slowly. These doctors want to stretch the tissues manually, or massage the area, or just make an episiotomy as a means of speeding up the birth process. Time is their main problem - they don’t want to wait and “do nothing”.

Women too, have lost a lot of confidence in their capacity to give birth well. In today’s technological, “quick-fix” society, the appeal of this gadget may be in its claims, backed by research, to reduce the incidence of perineal trauma. For some women, choosing an appropriate caregiver (e.g. a midwife) would be a better way of reducing the risk of tearing during birth, but many women may not be able to make such a choice, or are unaware of the significance of midwifery skills. .

The position of the woman as she gives birth is also a potential problem. In an upright position the vagina has more even pressure applied on all sides, encouraging better stretch. If the mother is recumbent, or even worse, flat on her back, there is considerable pressure on the area between the vagina and anus, and the whole perineum tends to be thinned and over- extended by the pressure of the baby’s head. This is much more likely to lead to an unnecessary episiotomy if the caregiver believes that a nice clean cut (episiotomy) is better than a tear - a situation prevalent in many hospitals where evidence based care is not the norm.

Women who use an EPI-NO are sending a signal to their caregiver that they care about intact tissues and are prepared to use this equipment during pregnancy to improve flexibility and stretchiness of their vaginas. Perhaps this is one reason why the research, especially the studies done in Israel where episiotomy is almost 100%, shows that intact perineal rates can be significantly improved when women use an EPI-NO during the last weeks of their pregnancy.

If buying and using this gadget is what it takes to avoid an episiotomy then that’s OK by me. Not all women can count on having a caring midwife to facilitate the gentle arrival of the baby and a caregiver who knows that a woman have taken a lot of trouble to avoid tearing or an episiotomy may be better prepared to wait.

Posted by andrea at January 15, 2005 01:36 PM