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Written By: Cathy Daub, PT (BWI President) When I first read about one of the latest new innovations in technology called the EPI-NO, my thought was, “What will they think of next?” This is a device whose purpose is to increase pelvic floor musculature during pregnancy, and after 36 weeks to stretch out the perineum so that at the time of birth, it will help to prevent the need for episiotomy, reduce the risk of perineal tears, incontinence, and improve overall sexual health. Says Dr. Wilhelm Horkel, the Inventor of EPI-NO, "The human body performs more efficiently in any physical activity when the body has trained and prepared for it. Childbirth is no Exception" Advocates of EPI-NO say it is clinically proven to significantly increase the chances of an intact perineum, increase control during delivery, that it is more effective than perineal massage and that it offers women considering having a cesarean another option. A German Study indicated a shorter 2nd Stage of Labor and better APGAR Scores for EPI-NO babies. I don’t know about you, but personally, I wouldn’t want my perineum stretched out before labor. Tissues of the body need to maintain their flexibility. They do this by contracting and relaxing as in muscles including the uterus, or by opening and closing, as in sphincters. I don’t believe that it is healthy for such tissues to maintain a lengthened relaxed or opened state for longer periods of time as that can affect their flexibility. I believe that at the time of birth, if women are in anatomically advantageous positions for birth (not lying on their backs), and if they breathe their babies out, avoiding forceful pushing, their perineums know how to open just fine to give birth. At the moment of birth, hormones are being secreted to assist the process of birth as they have for women around the world for thousands of years. The EPI-NO sends a negative message to women that their perineums need help to stretch out! Women need to have trust and faith in their bodies’ ability to give birth. I also don’t like the idea of inserting foreign objects into my vagina. And how about the kegel exercises? They work just fine in strengthening the pelvic floor musculature. The following is a more detailed description of the device. I’d like to know what you think!  Description:Prepare your perineum before birth after 36 weeks of gestation by simply inserting a balloon two-thirds of the way into your vagina and then inflating it with a pump to your level of personal comfort. Increase the size of the balloon daily from one session to the next, each lasting about 20 minutes. You have achieved optimal training when the balloon has reached a diameter of 8.5-10cm (3-4 inches), and you can push it out while it is still inflated. The EPI-NO balloon is soft, easily inserted, and naturally shaped so that it fits the vagina perfectly. EPI-NO must be used only with a water based lubricant. Buy your kit now. It includes a narrow contoured silicone balloon, a hand pump, a pressure display, an air release valve, and connection by a flexible plastic tube. It is recommended that women consult a health professional before using EPI-NO.  1. EPI-NO Pelvic Floor Muscle Exercises can commence early in pregnancy. A strong pelvic floor supports the weight of childbearing, and is more resilient in it's recovery after the birth. A strong pelvic floor provides more control during delivery. In these exercises the balloon acts as a sensor and is only minimally inflated. Following the birth Pelvic Floor Muscle Exercises recommence after 4-6 weeks and can continue indefinitely. EPI-NO provides bio-feedback on Pelvic Floor strength. 2. EPI-NO Stretching Exercises commence after Week 36 and continue until the end of the pregnancy term. These exercises gradually stretch the perineum in daily sessions of 20 minutes each, comprising several cycles of 5 minutes duration. In these exercises the balloon is inserted and inflated at the perineum. Women training with EPI-NO will normally achieve a dilation of between 8.5cm and 10cm over 3-4 weeks. Women achieving 8.5cm will achieve the extra 1.5cm when the head is crowning. Following the stretching exercises the balloon can be glided out, simulating the experience of control during delivery. Feel free to leave your thoughts in the comments section below!