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Americans Gets the Shaft: The EpiNo- A Potential Preventative Tool for Tearing During Childbirth

I recently learned about an innovative piece of birth preparation technology. It’s called the Epi-No.

If you are American, don’t get too excited yet, because in order to get your hands on one you will have to get stealthy. Not FDA approved.

What is it? Leave it to the Germans to design a biofeedback system to measure pelvic floor strength. The idea is that you can actually prepare your birth canal for birth. You insert this inflatable silicon piece and you pump it up slightly until there is something to resist against. You both squeeze and see how long you can sustain the muscular effort and then also release it.

If you are preparing to give birth, in the last three weeks of your pregnancy, you begin to inflate the pump centimeter by centimeter, and over the course of the three weeks, get all the way to 10 centimeters. So you have basically conditioned your vaginal walls to stretch as much as they will need to (or almost) as they will need to when the baby comes down. This has a physical effect and also a mental one, to really “know” that your body can do it.  I am really excited about the possibility of this for Brazilian women- who often believe that the reason they need a Cesarean is that they don’t have the “passageway.”

Normally I am a total non-interventionist, for myself. Hard to locate an advil or tylenol in my house. At 41 weeks and 5 days of gestation, my midwife had to drag me to get an ultrasound. However, based on the high numbers of C-section rates, and the increasing difficulty of women giving birth worldwide, I am thrilled that non-surgical options are available- preventative measures that increase the possibility of a birth without episiotomy and tearing and a more joyful post-partum experience.

As part of building the Magamama community, I have been interviewing visionary women from around the world on birth and the post-partum period. While talking with Jennifer Mayer of Mamamoon NYC, we agreed that long distance runners, dancers, and long-time yoga practitioners seemed to have high incidences of pelvic floor tearing in our anecdotal experience.

I am optimistic about the possibility of the EpiNo to be one potential option as a preventative measure. Most pelvic floor experts agree these days that pelvic floor “dysfunction”- which includes peeing when you sneeze, not being able to hold it, is caused by hypertonic (overly toned and chronically tight pelvic floor muscles) not by loose and flacid muscles which is the common conception, and what sends women Kegeling at every stop light.

Ideally our pelvic health education would begin when we menstruate, but most women have never even heard of their pelvic floor until they are pregnant. We would learn how to push down (as if having a baby) on the frontal pelvic floor muscles, actually inverting the vagina 30%!  During pregnancy it is too late to access the full range of pelvic floor movement.  When you are pregnant, you don’t want to be pushing down onto your pelvic floor, unless you are ready to give birth!

So one preventative measure for tearing is to include this pushing or bearing down movement in breath based pelvic floor exercises, and I do include this in many of my all-women yoga classes, so that before becoming pregnant women are already aware of their ability to push down. Newsflash: giving birth is NOT like pushing out a large bowel movement. Thinking of it that way could cause damage- to be discussed in later post.

If a woman has not ever pushed down on these muscles, and has spent years pulling them up (dancing, running, horseback riding), it is HIGHLY likely that those muscles are highly toned and rigid. Relaxing them is not enough- they are still in an overly taut state. So what can she do? Perineal massage is sometimes recommended, although research does not show significant benefit. Water is highly suggested, spending a good part of the dilation phase in a tub. Of course, everything we know about the environment- birthing in low light, in a safe place, with minimal interruption and maximal privacy. I know a number of women who were longtime yoginis, who had these “ideal” conditions and still tore a significant amount.

I am hoping that the EpiNo can be a possible solution. Mine is in the mail. I am *extremely* excited to have an actual gauge to allow me to measure both the strength, sustenance, and release of my pelvic floor muscles. Tangible evidence is very satisfying, sobering and satisfying.

I remember when a friend of mine told me she was using a natural fertility method. Inside I rolled my eyes and thought “right, the rhythm method, everyone knows that doesn’t work.” She read my mind and showed me a machine she and her boyfriend has bought (they still have an extremely egalitarian relationship) together from Canada. The little alarm clock kept track of all the information she entered as she took her temperature each day- it gave a red or a green light. If it have a red light, it was a potential fertile day and they used a barrier method. Genius. I wanted one. Turns out you can only get them in Canada.

Maybe someone will write here and tell me exactly why the FDA rules are so necessary. In the meantime, I plan to be proactive about remaining informed about these women’s health innovations available worldwide. (The EpiNo HAS arrived in Brasil)

I promise a thorough report when my EpiNo arrives. I hope it meet my expectations. In the meantime please feel free to leave any comments or questions that you have about pelvic floor health!






Kimberly Johnson, is an American woman in love with Brazil.

Yogini nomad, international yoga teacher trainer, and post-partum care revolutionary.


  • 48 years ago