THE EPI-NO? NO!!!!

- with special thanks to Cynthia Overgard -

There is a website for a device that is being distributed in England and Israel for pregnant women. This is what the website says:

It is becoming increasingly commonplace nowadays for midwives and ante-natal teachers to recommend the practice of perineal massage to pregnant mothers, with studies suggesting that it should be done daily from around 34 weeks to get the most positive effect. There is a product on the market in the UK called Epi-no, which can facilitate this massage and provide a controlled, uniformed and gradual progressive perineal stretch. This will help reduce the risk of perineal trauma such as grazing and tearing or the need for an episiotomy. Additionally it can also be used after the birth to regenerate the strength and tone of the pelvic floor muscles. It is becoming increasingly commonplace nowadays for midwives and ante-natal teachers to recommend the practice of perineal massage to pregnant mothers, with studies suggesting that it should be done daily from around 34 weeks to get the most positive effect.

It won't surprise anyone to know that this device doesn't sit right with me (and that that was a pun).  Please listen up so that when you bear down, your vagina will be just the way it is SUPPOSED to be when you bear down. An Epi-no? NO! 

First of all, perineal massage is NOT recommended. It breaks down the tissue. I remember when we used to recommend this practice - back in the dark ages. Women would call me and complain that it didn't feel good.  They would tell me that they couldn't get their husbands to do it with -or for - them.  They saw it as yet another chore that had to be checked off on their never-ending "to-do" list. Love making often turned into an argument about how the perineal massage should be done, rather than spontaneous, intimate, enjoyment.

When I shared the ad for the Epi-No with the woman who was one of my main mentor midwives, she responded: "OMG!  This is so stupid!  What makes the perineam stretch are the wonderful birth hormones!  Over stretching disallows perineal integrity and the ability for the tissues to go back to normal after the birth!" Another very experienced midwife wrote that she and her partners do not recommend it, as they believe that the body knows how to soften a cervix. She remarked that the EPI-No takes women that much further from our bodies and our consciousness, " but in our fear-based culture women are terrified of their own bodies" - and of birth.   "I wonder," she said, "if the aspect of getting to know yourself 'down there' is one that can be a benefit for some [but not via the Epi-no. Sigh]." Another said, "Everyone is so concerned about infection - these devices could be suspect."  Several midwives also remarked that for a woman who has a history of sexual abuse inserting any object into the vagina could unnecessarily reactivate feelings of violation and trauma.

What we know is that women's bodies were designed to give birth and that they don't need articles of torture to make this happen. Can you imagine other mammals taking the time to do perineal massage? "Dear, would you forgo hunting tonight; we have to massage my vagina," said the lioness. Relaxin begins to circulate through the body and softens everything in preparation for birth without plastic and metal objects of torture being inserted into our bodes -talk about feeling violated! And because the relaxin doesn't begin to circulate until the end of pregnancy, no wonder perineal massage is uncomfortable. The discomfort/pain is not a sign that the skin is not stretching - it is a sign that the skin is NOT SUPPOSED TO STRETCH like that six weeks or a month before delivery. 

 I attended the birth of a first baby this summer - ten pounds seven ounces, and no tears for the mother. A good diet, a patient midwife, the right position for the mother and certainly attention paid to the right head position of the baby starting in pregnancy, warm compresses and gentle support if the mother wants it at the right time, a nice easy breath with each push - these are the things that help a woman to stretch and not to tear. This Epi-No will increase the chances of tearing. Anyone want to volunteer to be in the control group of women who have to insert this thing and blow it up on a daily basis for several weeks before their "due date?"

 Someone is out to make money and to play upon women's fears. I am reminded of a showing of medieval torture devices that I saw in a museum exhibit years ago. We do not need even more concoctions and rubber hoses and tubes and tools put into our vaginas to stretch them.  It is interesting to note that years ago, when episiotomies were done routinely, we all heard about the "husband's knot" - a final stitch put into the woman's vagina to tighten everything up and make things "better" for sex. What confused vaginas we must have - stretch 'em out, tighten 'em up.  The penis changes shape to get the baby in and the vagina changes shape naturally to birth the baby out.

 This Epi-No is one of the next products coming down to adorn the shelves of obstetrical and mEdwifery offices. Shame on those who are recommending it to women. Of course, the ones who have had natural births themselves, and know from personal experience that the pregnant body was designed well and can open without injury in most circumstances, won't be suggesting each of the newfangled notions that are thought up by those who have little trust in birth.