Birth trainers – are they for everyone?

Many expectant mothers ask us about using birth trainers such as the EpiNo in preparation for labour. The idea of stretching the perineum in preparation for a vaginal delivery is of course not new with perineal massage being used for decades if not longer. The EpiNo device has been around for a number of years now and has become quite popular with its aim to help decrease perineal tearing.

There is various anecdotal support for its use, with a number of specialists and physiotherapists encouraging its use. However the research currently is just not there for us (as Women’s Health physiotherapists) to strongly recommend that its use will significantly decrease the likelihood of perineal damage. The one major paper published to date is quite biased and of poor quality. A couple of other smaller European studies were also quite poor.

We are waiting in great anticipation for the Dietz et al study looking at the use of the EpiNo and the incidence of Levator avulsions. But again this is not looking at a decrease in perineal damage.

Our current opinion is that the EpiNo may be useful for women with a strong fear associated with second stage labour. It may be used along with other techniques (mental imagery, movement, breathing, vocalisation, muscle relaxation) to decrease this fear whilst simulating the stretching sensation associated with second stage labour.

It may also be useful for those women with a history of pelvic floor muscle overactivity or pelvic pain syndromes. Again the focus would be on learning to relax the muscles and tissues and calming the mental and physical responses to stretch. These women I would suggest work closely with a Pelvic Floor physiotherapist throughout the second half of their pregnancy at a minimum.

Our main concern is the concept of repetitively stretching the vagina – the manufacturers’ recommendation is to dilate the device to 10cm for up to 15 minutes a day and then push it out. This appears excessive and not supported by the literature or theoretical mechanisms. The main concerns are of the potential damage to the tissues which for the most part are meant to only stretch that much once (a pregnancy) with delivery and with support of labour hormones.

So in summary we (Vital Core Physiotherapy) are unable as Women’s Health physiotherapists to strongly recommend the EpiNo as a method of decreasing the likelihood of perineal damage. Further research is necessary.

It may however be useful to a particular subset of women of who we would encourage working closely with a Pelvic Floor physiotherapist in the lead up to childbirth.

Rebecca Sabine and Tory Toogood
APA titled Continence and Women’s Health Physiotherapists
Principal Physiotherapists
December 2013