Part TWO - EPI-NO Childbirth Trainer

By Kim Vopni, The Vagina Coach — Certified Pelvic Floor Fitness Specialist · Published October 4, 2021

How to Use the EPI-NO

The EPI-NO is made up of a silicone balloon that is attached to a pump with a gauge. On the gauge is a needle that registers movement. When you contract, the needle moves up, and when you relax, the needle returns to the starting position.

Insert the deflated balloon into the vagina and tighten the nob on the gauge.  Now gently squeeze the pump to add a bit of air to the balloon – enough to feel like you have something to squeeze against.  Now contract and relax your pelvic floor muscles – kegels. Use your pelvic floor muscles to hug the balloon and draw it upwards.  You can hold for 5-10 seconds and then release the contract and lift.  Repeat for 10 minutes. This is the contract/relax phase, and it can be done at any point in pregnancy.

For the perineal massage training, you start at 37 weeks of pregnancy. After your 10 minutes of contract/relax training, you leave the balloon inserted halfway and then use the pump to add more air. Pump up slowly until you feel a significant stretch. It should not be painful, but it will feel uncomfortable. Hold the balloon in place with your fingers or your partner can hold it in place. This is a time of allowing, not doing. You will be visualizing release and openness in your pelvic floor and will try and soften and let go of tension. This is done for 10 minutes.

After 10 minutes, you can let go of the balloon and see if you can relax enough to allow the balloon to come out still inflated. If needed, you can let a bit of air out and try to let it slide out.

Here are some helpful videos - 

EPI-NO How To Use (for childbirth)

Perineal massage in pregnancy with the EPI-NO (best invention ever!)

How to hold the EPI-NO balloon in. Pelvic floor training for childbirth.

EPI-NO How to Use for Kegels in pregnancy

When to Start Using the EPI-NO

You can start using the EPI-NO for Kegels at any point in pregnancy.  You will begin the perineal massage at 37-38 weeks of pregnancy.

Does the EPI-NO Work?

Users report a reduction in anxiety and more confidence about the birth. Studies have shown that users of the EPI-NO vs non-users have shorter pushing times, higher Apgar scores and a higher rate of intact perineum. Birth position, having a midwife and a doula and mind body work also optimize normal physiologic birth and increase the chances of having an intact perineum and avoiding an episiotomy. You can learn more about how to prevent tearing and optimize your body for birth in the Prepare To Push program.

• Clinical trials show a significant reduction of perineal injury in vaginal births
• The second stage of labour is considerably reduced, which lessens the stress for both mother and child
• Less analgesic medication is required
• Reduces anxiety and enhances your self-confidence about the delivery
• Simple to use and easier than perineal massage
• Biofeedback gauge improves the quality of pelvic floor exercises
• Optimal device for speeding the regeneration/ recovery process

How Often Should I Use the EPI-NO?

You can use the EPI-NO daily for Kegels, or every other day.  You will use the EPI-NO once or twice daily for 10 minutes for perineal massage from 37 weeks onwards.

Can the EPI-NO Induce Labour?

No, the exercises that start 3 weeks before the calculated due date cannot be used to induce premature birth. In the clinical study, there was no evidence that EPI-NO could induce preterm labour.

Where to Buy the EPI-NO

EPI-NO is manufactured in Germany by Tecsana.  There are many international distributors listed on their website

Why is the EPI-NO NOT available in the US and CANADA?

In 2019 Health Canada implemented a new medical device licensing mandate that was much more costly and had more hoops to jump through. As a result, many smaller manufacturers chose to leave the Canadian market. You can learn more HERE

In the early 2000s, a woman in the US used the product incorrectly and had a negative experience that she reported to her doctor. (The mother and baby were both unharmed). The doctor reported it to the FDA and the FDA declared it a dangerous device that required a higher-level classification that was very costly.  Tecsana chose not to maintain classification in the USA.

 Additional Resource:

5 Tips for Perineal Healing Postpartum

Direct Answer

Part Two of this series explains how to use the EPI-NO for pelvic floor contract-relax training and perineal massage during pregnancy, when to start each phase, and where to buy the device. It also covers the evidence behind its effectiveness and why the EPI-NO isn't currently sold in the US or Canada.

Key Takeaways

• The EPI-NO contract/relax training (kegels with the device) can be done at any point in pregnancy.
• Perineal massage training with the EPI-NO begins at 37–38 weeks of pregnancy, gradually stretching the tissue in a gentle, non-painful way.
• Studies show EPI-NO users have shorter pushing times, higher Apgar scores, and higher rates of an intact perineum.
• The EPI-NO is manufactured in Germany by Tecsana and available through international distributors, but it isn't currently sold in the US or Canada due to regulatory changes.
• For more support preventing tearing and preparing for birth, Kim recommends her Prepare To Push program.

Frequently Asked Questions

How do I use the EPI-NO for pelvic floor training?
Insert the deflated balloon, add a small amount of air, then contract and relax your pelvic floor muscles around it for about 10 minutes — this contract/relax phase can be done at any point in pregnancy.

When should I start perineal massage training with the EPI-NO?
Perineal massage training with the EPI-NO begins at 37 to 38 weeks of pregnancy, after you've completed your contract/relax training for that session.

Does the EPI-NO actually work?
Yes — studies show EPI-NO users report shorter pushing times, higher Apgar scores, and a higher rate of intact perineum compared to non-users.

Where can I buy the EPI-NO?
The EPI-NO is manufactured in Germany by Tecsana and sold through international distributors listed on their website, though it currently isn't available in the US or Canada.

Why isn't the EPI-NO sold in the US or Canada?
Regulatory changes — a new Health Canada licensing mandate in 2019 and a stricter FDA device classification in the US — led the manufacturer to stop maintaining classification in those markets.

What if I want more guidance on preventing tearing during birth?
Kim's Prepare To Push program offers additional support for preventing tearing and optimizing your body for birth.