EPI-NO How To Use (for childbirth)

hi this is Kim botany the Fitness doula

and I'm here today talking to you about

the EPI no I wanted to give you a couple

of best practices for use so the EPI no

is a product designed in Germany epi no

stands for no episiotomy and it was

designed as a preventive tool for women

to use during pregnancy to help prepare

their pelvic floor and perineum for

childbirth with the aim of reducing

things like episiotomy tearing

postpartum incontinence and what have

you so the EPI note can be used at any

point in your pregnancy for the up down

training which is strength and relax so

I'm going to show you a little bit about

that that means right now the balloon is

a silicon balloon in the deflated mode

the interior part when you squish it

down is about the size of a small tampon

okay and you want to lubricate the

balloon and/or yourself prior to use

once it's lubricated you want to insert

the balloon in the deflated mode up to

the halfway mark so you can kind of see

that little indentation there that's

roughly halfway so we insert that into

the vagina and then at that point you

now tighten up the small little nozzle

nozzle on the side and you're ready to

go now we want to add a little bit of

air into our balloon so we're going to

pump using the black pump on the hand

that we're going to squeeze that gently

and a small amount of air has gone into

the balloon it does not matter what

number you are at on the gauge you want

to see what number it is where you start

but it doesn't matter where that

starting point is so take note of that

it's at a six right now and that is

going to fluctuate for you on any given

day depending on how much tension you

have in your pelvic floor as well so

just take note of it from a starting

reference point it doesn't matter what

that starting number is so we have it

inserted halfway we've got our starting

number on the gauge and now I want to

perform a pelvic floor contraction so as

I contract against the balloon I should

look and be able to see on the gauge

that I can increase the number so I

should be able to move that needle

upwards with every contraction okay once

I can see that I can do that and I can

move that

I want to be able to increase the amount

of time that I can hold that contraction

so I'm going to contract and hold for

about five eight seconds or so

continuing to breathe while I do so and

then at the end of that five or eight

seconds relaxing the pelvic floor and

allow that needle to come back down to

that starting number okay

and a lot of people ask me what's the

best position to be in when you're using

the EPI no and it really depends on

where you're most comfortable you can do

it in a semi-reclined position so if

you're in bed prop a couple of pillows

up against your wall and some of your

client position I do recommend that you

put a small rolled up towel perhaps

underneath your back so that you can

keep a more neutral spine which will

allow your pelvic floor to function more

appropriately if you take yourself on to

a sideline position you can also do that

you can take a couple of pillows and put

them in between your knees if it's hard

to hold your your top leg up and you can

perform the exercises in a sideline

position you could also do it in a

standing position so you can kind of

play around where you feel most

comfortable that the length of the tube

limits you a little bit but it does

allow you some freedom of movement the

next question I get when you're doing it

is some people feel like the balloon is

going to fall out that it's too slippery

if that's too lubricated and my answer

there is it's not a problem if you want

to hold it in so if you're in say a

semi-reclined position and this is the

way that I was doing it when I was using

it when I was pregnant you can put the

balloon the tube at the base of the

balloon in between your middle and index

finger and as you insert it I keep it

inserted halfway and then the heel of my

hand would rest on my pubic bone and all

I'm doing I'm not pushing the balloon in

I'm just preventing it from slipping out

so my fingers are there simply to

prevent it from slipping out if I have

too much lubrication or what-have-you

okay so it's not a problem if you have

to hold it in if you can do it without

holding it in great there's there's no

one way is better than another and it's

whatever works best for you

so wherever you're able to keep it in at

the halfway mark and get the best

ability and function that's the best

place for you

so the up-down training which I just

showed you when you contract and relax

can be done at any point in your

pregnancy whether you're 13 weeks or 33

weeks or anything in between it's done

for 10 minutes a day and at the end of

your 10 minutes you want to let the air

out you want to wash with soap and water

air dry or towel dry store it back in

its storage pouch ideally also back in

the box and you want to keep it away

from children and pets

specifically dogs because they happen to

think that this looks like a really

tasty Kong so storing it away properly

is about most importance as well in

terms of keeping the longevity of your

pepino unit as well once you reach 37

weeks so your 3 weeks prior to delivery

you're now going to do the stretching

component as well as the up down

training so at the end of your ten

minutes of up-down training contract and

relax you're now going to stretch the

perineum and you're going to do this for

10 minutes as well and what you do here

you leave it inserted the same halfway

mark again not paying attention to the

gauge you're just going to gradually

inflate so I'm just squeezing the pump

and you squeeze again until you feel

slight discomfort or similar to when

you're in it in a stretch you only go so


so once you've reached that point I call

it finding your edge once you've found

that you're going to stay there for 10

minutes so you're just going to allow

the balloon to just gently and gradually

stretch the tissues around the vaginal

opening for 10 minutes it doesn't matter

what number shows up on the gauge in

fact you can just completely not pay

attention to it at all during that 10

minutes I give people visualization in

terms of relaxing and expanding allowing

softening whatever words are going to

allow you to sort of yield to that

resistance that you feel from the

stretching if you feel that the the

tension or that stretch sensation starts

to lessen you can add a tiny bit more

again you want to try to maintain that

edge so to speak for the duration of

that 10 minutes at the end of the 10

minutes what you want to do is allow

pelvic floor to relax so in so doing you

want to soften yield let go whatever

images are going to work for you and you

want the balloon to come out inflated

the reason for that is it's sort of

simulating what you need to do during

your birth as well you you need to be

able to relax those muscles and yield to

the resistance that you feel as your

baby is crowning in emerging through

your vagina so once the balloon comes

out in the inflated mode then what you

do is you take the measurement template

that's included in the box and you want

to hold your balloon up and it's a range

of you can do centimeters or inches but

there's a 10 centimeter diameter

measurement template here so you want to

take your balloon and figure out what

your starting point is so if this is

your first day using it you're going to

hold it up and you're going to be at say

a five centimeter diameter my first time

was four and a half might be too much

information but thought I'd share what

we're talking about is pelvic floor here

so at the end of the three weeks ideally

what will have happened is each day

you're going to be able to inflate that

balloon just a little bit more hoping by

the end of the three weeks you're at a

10 centimeter diameter that's what your

goal is

I reached nine and a half and my child

was born on his due date and I was at

nine and a half centimeters when I got

there so I was almost at the 10

centimeters not quite and but each day

you're able to gradually inflate it just

a little bit more as those tissues

continue to yield and relax and then

again you want to wash with soap and

water store it away properly and then

you're done

so that's done daily so from whenever

you start in your pregnancy to 37 weeks

you do 10 minutes of up down training

once you reach 37 weeks you do 10

minutes of up down training and then you

do 10 minutes of the perineal stretching

or massage or what-have-you and so

that's a 20 minute total in your last

three weeks of pregnancy one of the

biggest things that I found helpful with

this was I bought it initially because I

was afraid of tearing I was afraid of

tearing and I wanted to do everything up

possibly could to prevent that what I

found most useful for me though was the

actual biofeedback component so I was

able to look at what my pelvic floor was

doing did I have the ability to hold

contractions what was my endurance like

what was my strength how far could I

move my needle and then what I've

learned after in the research I've done

and what have you is the importance of

the relaxation so I didn't necessarily

take that into account when I was using

it myself but that's one of the most

valuable tools I find about the EPI now

is actually teaching people how to relax

and let go you need to be able to relax

and let go to give birth to your babe it

helps with the stretching as well and it

gives you that mind-body connection of

allowing something to come out of you so

it's an interesting process from that

point of view

restorative ly so after six weeks you

can use the tool again restorative ly so

we're looking to regain the tone the

strength the function regardless of

whether you had an intact perineum or

not we need to restore some form and

function so I definitely recommend that

you see a pelvic floor physiotherapist

around the six weeks the six week

postpartum mark but you can also start

to use your epi now as well again and

what you're doing now is the up down

training so again you insert it in the

deflated mode you want to lubricate your

balloon you insert it halfway you

tighten up your nozzle you add a little

bit of air with the pump just to the

point where you feel like you have

something to squeeze against make note

of your starting number again it doesn't

matter where that is just make note of

what the number is where you start and

then you'd perform the same thing you

contract hold that for a time of say

five to eight seconds or so and then

relax and also if you can coordinate it

with your breathing

ideally performing a contraction as you

exhale do you want to take an inhale

allow the pelvic floor to expand and

relax exhale contract your pelvic floor

and hold and then inhale as you relax so

I hope you found that helpful helpful

and if you have any other questions

please visit Fitness doula com Ora send

me an email I'd be happy to help thanks

so much