No Episiotomy! What you can do to prepare your body to prevent tearing in labour.

Dr. Michelle Peris

This weeks blog is written by Kim Vopni.  Kim is a pelvic floor specialist and the president of Epi-No Canada.  I have had the pleasure to work with her as I took her pelvic floor wellness class during my pregnancy and used the Epi-No to prepare for my labour.  Those who are looking to become pregnant, are currently pregnant or are wanting to strengthen their pelvic floor post- partum you need to read about the Epi-No.

It’s amazing to me that we do so much to prepare the body for other forms of physical stress like running a marathon yet there is little information or tools out there to help prepare women for the most physically demanding activity, childbirth.  It makes sense to take measures to prevent tearing or medical intervention such as an episiotomy.  Our body’s were designed to be successful at labour and there are things we can do to ensure that it is a positive experience.  Enjoy!

There comes a point in every woman’s pregnancy when the reality of giving birth hits home and anxiety sets in. For first time mums in particular, the fear of the unknown can be just a little overwhelming.  How painful will it be?  Will I tear?  What will it feel like after the birth?  Will my body go back to the way it was before?

Our bodies were designed to give birth and recover from birth, however in this day and age our daily life is far different from our ancestors.  We sit for the majority of our days, we hunch over computers, we eat prepared foods rather than growing, sowing and preparing our own.  We live a fast paced life with fast paced expectations.   Pregnancy and birth are not immune to these fast paced expectations with women running to the nearest mommy bootcamp the day after delivering to try and get back in their skinny jeans as soon as possible.  Unaware of the issues and challenges this can create, women encounter problems they didn’t even know about such as incontinence and pelvic organ prolapse.

Pelvic organ prolapse occurs when one or more of the internal organs starts to move downwards and in extreme cases, start to protrude through the vagina.  This is a condition very rarely, if ever , talked about and most women do not even know about it until they are faced with it themselves and feeling let down because no one told them about it.  Fears of giving birth typically revolve around fear of pain, fear of tearing and fear of a lingering mummy tummy.  No one thinks about the other issues pregnancy and birth can create either because they don’t know about them or because it is easier to not think about it and hope that it doesn’t happen to them.  Pelvic floor dysfunction (PFD) is one of the most common issues women face postpartum and it is more common than people think.  PFD  is becoming even more common with the lifestyle choices we are making and it is of vital importance that women are educated on their pelvic floor so they know what to do to help maintain its function and what to do if they notice that things aren’t quite right.

The pelvic floor is a group of muscles, nerves, ligaments and connective tissue that run from the pubic bone to the tailbone that function to stabilize the spine and pelvis, support the internal organs, ensure healthy urination and bowel movements and contribute to satisfying sex – pretty important stuff!  Like any other muscle group, the pelvic floor muscles can become weak from underuse, get injured during childbirth or become dysfunctional from chronic tension which leads to pain and discomfort. Unfortunately for many women, they don’t know about these muscles until they are dealing with some type of dysfunction, usually after they have had a baby. By getting to know your pelvic floor prior to childbirth, you and your pelvic floor will be ready when it comes time to push your baby out and will be in a better position to prevent unnecessary challenges.

The second stage of labour (the pushing phase) is often the most dreaded with tearing and episiotomy being common fears. As the head emerges, the area between the vagina and the anus, called the perineum, can tear or be surgically cut (episiotomy). By strengthening and stretching the muscles and tissues of the pelvic floor before delivery you can prevent perineal trauma such as tearing.

Tearing ranges in degrees from first to fourth degree. First degree tears are small and superficial and typically heal naturally. Second degree tears are deeper and affect the skin and muscles of the pelvic floor and need to be repaired with stitches. Third and fourth degree tears involve the skin and muscles extending down to the anal sphincter with fourth degree tears extending even further into the anal canal and rectum.

While tearing is certainly not ideal, it is better than an episiotomy. Women who have an episiotomy often lose more blood during delivery, report longer, more painful healing times and are more likely to have weak pelvic floor muscles after birth. They are also more prone to infection, decreased sexual satisfaction and are at a greater risk of suffering third and fourth degree tears during the birth when the incision itself tears.  By preparing the pelvic floor for pushing, women will have strong, flexible and healthy muscles that will perform better, be less likely to become injured and that will recover more quickly postpartum.

Pelvic floor exercise is the best way to prepare to push and prevent perineal trauma. Strong, flexible muscles are able to support the weight of the growing baby, are able to relax to allow the passage of the baby’s head and are able to return to optimal function post partum. Women with a strong and functional pelvic floor will also be less likely to experience post partum incontinence, pelvic organ prolapse and pelvic pain. Pelvic floor exercise should involve functional training that involves contracting the muscles, holding the contraction and releasing the contraction. This is critical for birth – if you are not able to release and let go of the tension in your pelvic floor, you may encounter difficulty in birth and may be more likely to tear.  During the final weeks of pregnancy adding a stretching component to the pelvic floor training will also help prepare the perineum for birth and reduce the likelihood of trauma.

An ideal partner for pelvic floor training is a product called the EPI-NO. The EPI-NO – short for ‘ No Episiotomy’ is a revolutionary biofeedback product that helps women functionally train their pelvic floor while also preparing their perineum prior to birth.  It is also used postpartum to help regenerate tone and strength helping to prevent postpartum incontinence and prolapse. The EPI-NO allows women to see whey they contract, if they can sustain that contraction and if they can release that contraction.  This element of releasing the contraction is one of the aspects of the EPI-NO that makes it so valuable.  Many women are not aware that they hold tension in their pelvic floor and by taking advantage of the biofeedback of the EPI-NO, users can see when they contract but also when they relax and if they can relax completely.

Based on well-known principals of stretching and strengthening muscles to train for an event, the EPI-NO gives expectant moms a way to prepare ‘down there’ for their upcoming birth. The EPI-NO is based on a traditional African practice of stretching the perineum and pelvic floor muscles with the use of gourds, to reduce the risk of perineal injury. The EPI-NO was developed by Dr. Whilhelm Horkel who witnessed this use of gourds and took that philosophy back to Germany.  He worked with a team of gynecologists, midwives, urogenital physiotherapists and pregnant women to develop an innovative product based on a nature-inspired tradition.  Comparing users with non-users, clinical trials have shown a significant reduction of perineal injury in vaginal births as well as a shorter second stage of labour.  Not only does this lessen the stress for both mother and child, but a shorter pushing phase also helps protect the pelvic floor as well.

The benefits of the EPI-NO extend beyond preventative.  The product is also used postpartum to help regenerate tone and strength and can also be used with subsequent pregnancies within a 5 year period. The EPI-NO is manufactured in Germany and is sold worldwide in over 20 countries.  In Canada, the EPI-NO is sold by EPI-NO Canada Ltd, a pelvic floor wellness company based in Vancouver, BC.  Kim Vopni, President of EPI-NO Canada, used the product herself for both of her pregnancies and even with an 8 pound 3 ounce son who crowned sideways (the widest way to crown) she still had no tearing or abrasions.  Based on her experience with the product she became a distributor and is now an advocate of preventative and restorative pelvic floor wellness.

For more information you can visit