EPI-NO, the anti-episio device

EPI-NO is a device that inflates a balloon in the vagina during preparation for childbirth, to reduce the risk of tearing or episiotomy. Midwife in Paris 16 (Espace natal), Anne Sophie Moulois * uses this technique. She tells us about her clinical experience.

The EPI-NO method, kesako?

EPI-NO (Epino) is a device created by a German doctor, still little known to the general public and which is not unanimous among all practitioners. The technique is inspired by what this doctor observed during his stays in Africa when he discovered that women used calabashes to prepare their perineum for childbirth. The EPI-NO device is a small balloon connected to a pear so that it can be inflated at the level of the perineum of the mother-to-be. The goal is to achieve a diameter close to that of a baby's head.

You should know that the perineum is a set of muscles in the small pelvis that are used to support organs such as the bladder, uterus, intestine. During childbirth, these muscles will be extremely stressed by the passage of the baby's head. When the perineum is too toned, it can cause lesions such as tears, or which are induced by the healthcare professional through an episiotomy (to avoid a large tear). " The purpose of the device is to help build muscle and soften the perineum. This includes relaxing the muscle fibers so that the perineum remembers this preparation on D-day. When the head passes, the perineum is more able to adapt, which reduces the risk of tears or episiotomy », Explains Anne-Sophie Moulois.

Beyond that, the EPI-NO method is part of an awareness-raising process for the perineum. EPI-NO is one of the aspects of this teaching like massage or learning to push. This method is particularly relevant for first-time mothers or mothers who have had an episiotomy or tears during a first childbirth.

A safe method?

The EPI-NO method can be started around the 5th month of pregnancy, but some midwives or gynecologists will start later, around the 6th or 7th month, or even the last month when any risk of prematurity has been ruled out in the patient. baby. " For my part, I find it interesting to start early enough in the pregnancy so that the pregnant woman has time to progress alone at home. Usually, it goes fast 3 to 7 cm, but then there is stagnation. Of course, the further into the pregnancy, the more easily the perineum relaxes thanks to the hormonal impregnation », Says the midwife.

The EPI-NO method can never be performed without the consent of a doctor or midwife. Each month, the mother-to-be must receive follow-up from her practitioner who gives her the green light. Because there are indeed contraindications such as a urinary tract infection, placenta previa, the threat of premature delivery, vulvar varicose veins, metrorrhagia (blood loss) or even an indication for a cesarean delivery. " The balloon does not touch the cervix, but we will avoid practicing the method in these cases to avoid taking any risks. The uterus is a muscle and it is the uterus that causes contractions. As it is already very used during pregnancy, we will not tire it even more by soliciting the perineum », Reports the specialist.


Concretely, how is it going?

Initially, the mother begins with "streching" exercises to develop the flexibility of her perineum and prepare it for training. These exercises consist for example of tightening and then releasing the perineum on the ball. The device allows you to see if you can contract the perineum since a small needle will indicate whether the woman is tightening or relaxing the perineum.

Then, the session begins in earnest, lasting about 15 minutes. " The goal will be to inflate the balloon with the bulb until a feeling of discomfort is felt. Namely, you never work in pain because that would be counterproductive. The ideal is to do the session when you are relaxed, such as in bed or on the sofa while watching a series ", advises Anne-Sophie Moulois.

During the 9th month, mothers can practice pushing in a dedicated session under the mandatory supervision of a midwife. " This helps the mom gain confidence in her pushing technique. But you always have to be careful. The mother should never practice the technique alone at home, because it is not trivial », Warns the midwife.

How effective is the EPI-NO technique?

For Anne-Sophie Moulois, the technique allows the mother to prepare both physically and mentally for childbirth. " The push is an extremely intense time for mom. Physically, it's like a marathon. So I think it is necessary to prepare the mind which will take over when the body is exhausted. I find that this technique allows women to reclaim their body during childbirth. I think this lessens their fears because they are really involved in their preparation and are familiar with certain sensations ”, underlines the midwife.

Let’s not forget that the purpose of the technique is also to facilitate childbirth from a physical point of view. A study has shown that the duration of the expulsion could be reduced by 25% in the case of a first baby, which therefore allows the mother to come out of childbirth less tired (Study Ruckhäbere 2009, 270F). There is also a decrease in the number of perineal injuries and tears. " In the field, the team I work with has the impression of observing a decrease in instrumental extractions for insufficient expusive efforts, but studies do not show it ", reports Anne-Sophie Moulois.

Last advantage of this training according to the practitioner: a better awareness of the perineum, with the key to a better post-childbirth perineal rehabilitation. Finally, you should know that there is no risk of perineo-vulvar enlargement, and that this aspect is checked postpartum.

The testimony of a mother who followed the EPI-NO method

" From the start of my pregnancy, my gynecologist told me that I would probably have a "big baby". Weighing 4kg myself at birth, I knew my mother had to undergo an episiotomy. My gynecologist quickly told me about a German method that he said drastically reduced this act. My midwife accompanied me to use it while never altering the position of the cervix. The progress was rapid at the start which was quite motivating, then there was a plateau around 7cm. The goal is to reach 9 cm (baby's head). In the weeks preceding the term, the exercises must intensify to reach or at least approach this goal.

But what I found great and which I think was the most useful to me was the use of EPI-NO at the very end of my pregnancy with my midwife during the preparation course for the baby. birth dedicated to pushing. EPI-NO allowed me to have the sensations I was going to feel in the delivery room and reassured me about the effectiveness of my pushes. The result: a delivery that went well (no tearing or episiotomy). I recommend EPI-NO as a good experience to take ownership of your body and feel things better ".

In practice: Price of the Delphine Plus EPI-NO Kit, € 116.40
A reimbursement of € 25.92 is possible by health insurance from the 6th month.

* The midwife specifies that she has no connection with the laboratory.