By Andrea Robertson - Birth International
15 September 2009

There was an interesting discussion on the ozmidwifery list a few months ago regarding the use of the Epi-No vaginal dilator as a preparation for birth. Several contributors thought that it was a useful tool and quoted anecdotal evidence of good outcomes. Others thought it was a bit strange, and using a gadget to stretch perineal tissues was seen as mildly distasteful (ed.but no more so than using one's thumbs, - or the partner's!)

A study undertaken in Israel has now been published that compared perineal outcomes for women who used the Epi-No and women who did not, in a culture where episiotomy a is routine part of birth management. In this climate, many women have tried the Epi-No as a means of avoiding this routine procedure and many hundreds have used it over the past 4 years.

Using a descriptive, retrospective approach, all women who had bought the device before April 2002 were contacted and surveyed. The results were compared with published episiotomy rates for the same period. When analysed, the results showed that users of the vaginal dilator had lower episiotomy rates than women generally, and there was an increased confidence in giving birth amongst users, who felt better prepared for pushing and the sensations of birth. There was also a reduced need for episiotomies when vacuum was being used.

It seems that this device may have its uses, particularly for women who fear second stage and face birth in a climate of routine episiotomy. It costs around $180.00, and takes time and commitment to use. It may not be attractive to all women but for some, it seems to provide a useful alternative to routine perineal surgery (ed.and an alternative to women turning to Caesarean Section out of a fear of vaginal birth)

Reference: Slome Cohain J. MIDIRS Midwifery Digest. vol 14, no 1, March 2004, pp 37-41.

Judy Slome-Cohain is an American Israeli Midwife practicing in Israel, and a proponent of empowering women through natural childbirth choices.