OP: prevent tearing or an episiotomy

Not the most sexy thread...

One of the things women fear during childbirth is (perineum) rupture. Some fear the episiotomy even more: a surgical cut in the perineum to widen the passageway for a vaginal birth. Yes; that's exactly what it sounds like and you may get shivers! Some doctors and mothers in labor prefer to make that clean cut even before the risk of rupture is perceived. Even though recent research suggests that many of the proposed advantages of episiotomy may not be valid, it is still widely used in obstretics.

So: how to prevent that dreaded tearing or an episiotomy? I've heard of perineal massage. But have just stumbled on another gimmick on the market: the epi-no. This is a sort of balloon with which the woman practices to push the baby out.

The philosphy of the inventor Dr Wilhelm Horkel being: "The human body performs more efficiently in any physical activity when the body has trained and prepared for it. Childbirth is no Exception"

I wonder;
-is there anyone on this forum that has experience using such a device as the epi-no and would like to share?
-for those medical professionals among us; does this seem like a valid method to you? Would you recommend it?
-perhaps any other types of preparation to prevent tearing?

PS: No, I'm not pregnant, I've recently started an education considering childbirth. I've doubted putting this question on this forum, since it does not have emphasis on sex or relationships (although it is something a couple may be concerned about. And it could really influence your sexlife off course, given scarring etc...) Since I find that replies are generally valuable over here, I thought: just give it a shot :)


Posted: 30 Sep 19:20


OK, Red, not my field. Since leaving training the only babies I have delivered have been in the emergency room, by accident, or in stressful locations where no other medical assistance was available. With a consult with a midwife and a call to a friendly obstetrician, I found they were each profoundly disinterested. A review of literature showed up the original German studies and the small study in Australia, both oft-cited by Starnberg on the internet. Starnberg is the inventor/ marketer and that is worth noting.

The N. American and European approaches to episiotomy are generally different. The Americans, mostly, treat it as a normal part of childbirth and do the cut quite early and quite long. Europeans tend to wait until it becomes evident that it is necessary and make a smaller incision. There are many exceptions to this. The Americans tend to have fewer tears but long term results in damage to the genito-urinary system are not much different. The argument is that a clean cut, immediately treated is less likely to lead to infection or other damage; the other side, is not to cut when possible because any opening is a route for infection.

The epi is done to prevent tearing, mainly, of the perineum and does not usually result in cuts into muscle. It is possible that the anal sphincters are cut resulting in rectal incontinence or further surgery. If the suturing is not quite precise, the shape of the vaginal opening may be affected resulting in a degree of sexual dysfunction. The epi-No seems to be intended to gradually stretch the perineum giving it the elasticity (or looseness, I do not know which) to stretch over the baby's head.

Over the years, there have been many attempts at reducing the need - water birth, massage, heat and likely many more. The epi-No is a mechanical device that helps to train the woman for normal, spontaneous, vaginal birth. It is intuitively acceptable that this would work. Many things that re intuitively obvious, and work in small trials, in medicine do not work out in mass use.

I suggest you contact an obstetrical nurse at a nearby hospital and ask what doctors recommend the epi-No. That nurse, and the nurses who work with local obstetricians will be able to give you some insight and, even, introduce you to the doctors who may be recommending it.

I simply do not know enough to give a good response.


Posted: 30 Sep 19:20

I wish the epi-no was available when i had my children.I had an episiotomy when i had my twins,my son was breech and a cut was made to make more room to pull him out.I've also had a tear in one of my other pregnancies.I haven't had any noticeable problems and my husband never complained about scar tissue.But i'm a bit self concious as i'm getting divorced and am worried that any new partner might be turned off by the view down there

raunchy gal

Posted: 30 Sep 19:20

> and am worried that any new partner might be turned off by the view down there

* More than likely, a guy will not notice anything in the dark.

* If a guy does notice in daylight or dark and is somehow put off by a scar, more than likely you have the wrong guy.

* What about scars in other locations, or, any other disfigurement?

For most of us these are non-issues. If a person's disfigurement is of initial concern, most guys put it into perspective and deal with it.

You should not worry. If you do not make a big deal out of any of these, they shouldn't either.


Posted: 30 Sep 19:21

Thanks DD2 it shouldn't bother me i know and as you say if a prospective partner takes offense to my episiotomy scar,he's not worth a grain of salt

raunchy gal

Posted: 30 Sep 19:21

Thank you Brandye. I am curious what midwifes, obstetrical nurses have to say about this. And I hope there may be some research available...

Yes, it is true that our intuition fails us at times. But sometimes intuitively acceptable methods may work. For instance; the "guide to effective care in pregnancy and childbirth" by the Cochrane* library considers continuous (emotional, physical and psychological) support for women during labor and childbirth to be "benificial". The highest category! Proven by research it makes births faster and easier and decreases medical interventions. The benefit was only first discovered coincidentally as a woman in a researchteam started supporting the birthing moms, lead by her intuition. She had influenced the results of a study by Claus & Kennel. Which wasn't that good for the original research, but did trigger a lot more research on this support! :)

And same is true for medical procedures and interventions. Many are considered beneficial. They can be life-saving, for both mother and child! And many lives it has saved. But some common practices in hospitals, like putting women flat on their back during the second stage of labor, by this guide is considered "likely to be ineffective" and even "harmful". Now I'm not saying that medical interventions or procedures are wrong; certainly not! But I believe it is stated in this same report that obstetrics is the field of healthcare in which the practice is least based on research-results. Which I think is rather shocking and sad :(

(*to anyone who's interested: The Cochrane Collaboration is an international network of people helping healthcare providers, policy makers, patients, their advocates and carers, make well-informed decisions about human health care by preparing, updating and promoting the accessibility of Cochrane Reviews, published online in The Cochrane Library.)

> Thanks DD2 it shouldn't bother me i know and as you say if a prospective partner takes offense to my episiotomy scar,he's not worth a grain of salt

RG, you're so right; not a grain of salt!!!!!

I was referring to women experiencing discomfort themselves due to scarring, not the aesthetics. Though I can imagine your worries. I have recently participated as a volunteer in a project for women against shame, especially the genital area. How many women feel ashamed of what they look like in between their legs; even when not cut or molested or anything; just how they are...

And I think the emotional/psychological aspect of episiotomy is underestimated. I've met a woman who felt like she was mutilated. Off course she did realize the nurse never meant to mutilate her, only to assist the birth and it may very well have been a necessity. But the emotional impact was huge and no-one had ever asked her how she felt about it. When telling the story she cried in anger, pain and pure sadness.


Posted: 30 Sep 19:22

RR i wasn't asked either and as it is tehnically a small operation i was a little taken aback as i had never had any kind of surgical procedure prior to this.Although it was necessary as my second born twin was breech and his shoulders became wedged in my birth canal,he was two thirds of the way out and as his head was still stuck something had to be done immediately to rectify this dangerous situation,and i was getting too tired to push anymore.I guess i can think of it as a legacy,knowing that if it wasn't done i may not have my oldest son.He may have died at birth,and that thought is worse than any little scar will ever be.I've had no problems just an itch every now and then lol

raunchy gal

Posted: 30 Sep 19:23

RG, off course when it is needed, something must be done. As is so with any type of surgery. And you may feel gratitude towards the one who saved you, your baby or even both! But I don't find it strange people experience conflicting emotions. I know of more people who have "tiny scars" in other places, who feel highly uncomfortable with it. Even when a scar is hardly visible. I guess this is about the same.

Also, we shouldn't forget how intimate this is, which could make it more emotional. Because we don't talk about our genitals it makes it even harder to talk about these emotions, which in turn makes them grow stronger within. It gets too easily covered up in shame, because we're talking about our genitals with shame in the first place. Hell it is even part of several languages; for example in Dutch we literally call labia "lips of shame", pubic hair is "hair of shame", etc. To see a woman letting out all those emotions she kept inside, was extremely powerful. And it may contribute to her healing. It also emphasizes that the emotional aspect of birth and how each participant influences this, shouldn't be underestimated. If only that nurse had asked, explained or had given her attention while stitching, she may have felt less helpless, misunderstood and out of control.

O, and if anything is clear: Epi-No does not perform miracles. I seriously doubt whether such prior practice would help with a breechbaby who's shoulders become wedged in the birth canal. But in a regular birth... The idea Epi-No could physically prepare a woman seems logical. Just like women take birthing classes in breathing and pushing, why not really push something out? Even more so: I like the idea of giving women a tool to prepare themselves. If it only would take away some nerves prior to birthing and built some confidence, that could mean a lot. Apart from the physical birthing, it is an emotional process. One that leaves a very clear and strong memory that lasts a life-time! It is even considered a transforming experience. I am planning this careerchange, cause I'd like to contribute to making that memory a positive and beautiful one :)


Posted: 30 Sep 19:23

LOL oh my! Sorry, let me explain. While my American doctor was stitching up the epi back together I looked down and asked him "Aren't you done yet?"

But when you say Epi in America - we take it to mean the anesthetic shot given into the peri and not the snip itself.

RG - please stop thinking that you have to be physically perfect and unmarred to be attractive. You don't. I know ugly women who draw men like flies and, Lord knows, I am not an example of feminine perfection.

and RR the way to overcome fears is to face them. Yes, the thought of being cut may not be pleasant but the alternative is far worse and when one considers that the therapy/after care of the snip is to sit in hot water (hot tub anyone?) hey - it isn't half bad!

Next the dilation required is, on average mind you, 10 centimeters so go and find something 10 centimeters in diameter and contemplate passing that through your vagina. Yes, women have done this since the species evolved to its current form but - damn!, that's big. I am sure that the tension and stresses of giving birth would tighten the muscles so having the snip there if needed or as routine could be comforting. Ve haf vayz.

Besides which there's something a bit creepy about the Epi-No device.


Posted: 30 Sep 19:24

I believe every woman has the right to give birth in her own way.

Same goes for her wishes on preparing. So if her wish is to have a routine episiotomy, than it should be done. Though I would advice her to decide well-informed, as with every decision. And if she doesn't wish it, but during the process for medical emergency it needs to be done, off course it needs to be.

True, women have done it for centuries. And animals seem to be able to this completely on their own; no preparation, no doctors, maybe just a few friends present (like elephants and dolphins do). It is in fact a very natural process, that should be respected. And even more so; the mothers wishes should be respected. There are some to whom giving birth becomes problematic and that's what hospitals are for.

But does it being "natural" mean not preparing? I think there's a delicate balance between acknowledging that it is a natural process, but als acknowledging that humans have at times diverted from the natural path. The intellect being both a gift as a curse, since it feeds us with fear and disconnect us from our body and emotions. Unhealthy sleeping, eating, exercising-habits that are even more important to keep healthy when pregnant and in preparation to giving birth. Therefor this part of our humanity needs some attention as well.

Facing your fears is the way to overcome them. Which is why I wouldn't advice pregnant women to stick their heads in the sand; running away from fears they have. Moreover cause the fear could exceed reality and they will probably be confronted with it during birth (which is not only unpleasant, but could interfere with the birthprocess). So I'd advice them to try to name those fears and anxieties, but also the hunger for knowledge and curiosities. And work with that. Whether that's by a birthing class, pregnancy-yoga, buying an epi-no, watching birth-films and reading birthstories, going to a haptonomist to reconnect with your body, join a talkgroup of pregnant women, reading books, etc

I found a yogacentre in Amsterdam that sells the epi-no. I'll ask them for reviews as well.


Posted: 30 Sep 19:25

I would never advocate being ill-informed regardless of the topic.
I will acknowledge that some perople have difficulty sorting through information to separate the gold from the dross and some information - such as "Nose Approximation of Jovian Whistlers" - is incomprehensible for those not in that field. That was the fist time I had ever read three pages of text and not understood anything at all.

There is something rather interesting regarding pregnancy that is still being studied. Warrior Syndrome. It seems that if your sire is violent and your pregnancy heavily stressful, and if your ensuing young child witnesses or undergoes a traumatic and violent event - he/she will grow up as a violent person. Apparently it works as a pre-disposition setup first by genetics from the the father and second, the prenatal environment where the mother's constant release of Seratonin makes the fetus immune to its effects. Then this pre-disposition is triggered by the later traumatic event. Like snapping the safety catch off of a loaded gun. So perhaps there is some value to the old wives' tale of keeping pregnant women calm and happy?


Posted: 30 Sep 19:25

Really? That's interesting. I've heard of the genetics from a violent father becoming clear in the child, as so the impact violence could have in (early) upbringing. Given the seratonine and the fact we're learning more and more about how the environment influences unborns, I can see the logic. My guess is studies will continue for some time; it's so hard to distinguish between nature (genetics) and nurture (upbringing/environment), that I can certainly imagine the difficulty in researching pre-natal influences. Not to mention getting a clear testgroup... ;)

For now; let us keep the pregnant women happy! Their well-being should be reason enough :)


Posted: 30 Sep 19:25

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