:  Two effective tips using EPI·NO The balloon often slips out of the vagina: The best idea to avoid this is the following: Roll up a folded towel, so that it forms a 12 cm (3inch) diameter-roll and put it before the training between your thighs. If you now start pumping up the epi-no it will stay in the vagina very comfortable. Releasing the thighs peu a peu, the balloon will glide out softly. Best training: Start by inflating the balloon only enough to make it stiff enough to insert. Insert it 3/4 of the way, and do not blow it up more. Practice a few pelvic floor contractions and releases and watch the needle of the manometer. You want to know that you raise the needle when you contract your muscles and are able to completely relax your pelvic floor when you relax the muscles, and see the needle back to starting point. This is important because you want to build muscles memory that relaxes your pelvic floor while the head is crowning. After a few minutes of this, you pull out the balloon a little so that only half (1/2) is inside. Begin to inflate the balloon, (now you are not looking at the manometer as it does not play a part in the stretching exercises) and you inflate until you reach a low level of discomfort. You should not have pain, just a feeling of maximum stretching. Now you either hold it with your other hand or lay on your side and legs are bent and you hold it in with your upper foot or calf of leg. Try to stay like that for 10 minutes. You must hold it in because the balloon wants to jump out and you invest effort in keeping it in. If you feel comfortable your partner can assist you by holding the balloon. Repeat the stretching if the balloon jumped out. After ten minutes you stop holding it in, and let it come out. Then you measure how big the diameter is by putting it against the graph template in the instructions booklet. Relax during those ten minutes, listen to music, read, practice guided imagery, think positive birthing thoughts, and do breathing exercises, anything you wan... What is the difference between EPI·NO Delphine and DelphinePlus? The Plus in EPI·NO Delphine Plus is for the Biofeedback function as represented by the integrated pressure gauge to measure contractions when exercising the Pelvic Floor Muscles after birth. The EPI·NO Delphine does not have this biofeedback pressure gange which is replaced by a mirror as many former users requested. In short: EPI·NO Delphine is a Birth Trainer to prepare for birth. EPI·NO Delphine Plus is a combi-product: A Birth Trainer to prepare for birth and a Pelvic Floor Muscle exerciser for post-natal regeneration of the Pelvic Floor Muscles with biofeedback. What is an episiotomy and what consequences can it have? Episiotomy is a surgical procedure in which an incision is made in the perineum during the second stage of labor when the baby's head is crowning. It was thought that an episiotomy lessened the incidence of perineal tears. According to WHO, about 60% of women receive an episiotomy during their delivery. The cut is surgically stitched after the birth. The practice of performing episiotomies as a standard procedure is highly controversial. Women may experience complications after an episiotomy. Complications include: slow healing sutures; pain when urinating and during bowel movements and when sitting and walking. For many women, resumption of sexual intercourse after birth is painful and for some, long-term sexual dysfunction can result. When should I commence using EPI·NO? We recommend commencing the EPI·NO training three weeks prior to the calculated date of your baby's birth. Can I commence using EPI·NO earlier to be even better prepared? Optimal results with the EPI·NO training are achieved in the three weeks prior to childbirth. Commencing training earlier than the thirty-seventh week should be undertaken only under the guidance of your physician. How often and for how long should I train with EPI·NO? It is recommended that the EPI·NO be used once or twice daily for 10 to 20 minutes for each training session. Can EPI·NO training over-expand the vagina? No, quite the contrary. By gradually and naturally stretching the perineum as a precautionary measure it is possible to avoid long-term perineal damage. When you pull a tight sweater over your head, the neck expands and returns to its original shape. Similarly, during childbirth the opening of the vagina must expand to allow the passage of your baby's head. The EPI·NO training accustoms the vagina to the stretching required in childbirth and facilitates a return to normal. Can I use EPI·NO if I already have had a previous episiotomy or a perineal tear? Yes. The EPI·NO training stimulates blood circulation and the muscles. This can make scar tissue more flexible and easier to stretch. If you have local pain and discomfort consult your physician before starting. What can EPI·NO Training achieve? EPI·NO training occurs in 4 Stages. Stages 1 to 3 begin from the thirty-seventh week of pregnancy. In Stage 1 the pelvic floor muscles are exercised. In Stage 2 the perineum and the birth canal are gradually and gently stretched. In Stage 3 you prepare for the sensation of delivery by easing the balloon out of the vagina. In Stage 4 with EPI-NO Delphine Plus (four to six weeks postpartum) the pelvic floor muscles are restored (Kegel exercises) by applying pressure "squeezing” against resistance provided by the EPI·NO balloon. With the built-in biofeedback gauge you can measure and ensure the exercises are effective. Can I unintentionally initiate premature contractions or a premature delivery by training with EPI·NO? No. In the EPI·NO clinical trials there were no indications whatsoever for any premature initiation of contractions or of premature birth. The EPI·NO training should be undertaken under the guidance of your physician and should ideally begin three weeks prior to the calculated date of the birth of your child. Is it possible to accidentally puncture the fetal membrane by training with EPI·NO? There are no indications whatsoever from the clinical studies or from the observations made by obstetricians and midwives that it is possible to puncture the fetal membrane during the EPI·NO training. Is there any risk of infection? The danger of an infection was investigated in the clinical trials. The EPI·NO Birth Trainer is not used in a sterile environment. If the device is cleaned and disinfected according to the Instructions for Use no increased risk of infection is expected. We recommend EPI·NO for personal use only! Can the balloon burst? This is extremely unlikely provided the balloon is not inflated beyond 10cm. Each single balloon has been tested up to the size of a football. The balloon is consists of medical silicone. Please treat the balloon carefully according to instructions for use. Can I injure myself in training? As in all physical training, you should not exert yourself beyond your personal level of comfort. If you follow this advice there is no danger of injury. If you are not sure, do not hesitate to contact your physician or your midwife. How far should the balloon be inserted into the vagina during training? The balloon is inserted two-thirds of the way into the vagina. It will protrude about 2cm (0.8 inches) out of the vagina. Ensure that the balloon is inflated inside the vagina. If you can't inflate the balloon very much in the initial training session, securing the balloon can be achieved by closing the legs. This would also prevent the EPI·NO from slipping out of the vagina during training. To prevent the balloon from being drawn too far into the vagina, the protruding end can be held with your hand. It will take only two or three training sessions for you to determine the optimal position of the balloon to your body. Will EPI·NO training promote recovery after childbirth, and how does it tone the pelvic floor muscles? Yes. In actual fact more and more young mothers report that after-birth training with the EPI·NO, the muscles of their pelvic floor strengthen quickly and efficiently. Midwives, obstetricians and gynecologists also see an effective application of the EPI·NO in promoting vaginal muscle tone after the birth. Clinical trials currently underway are investigating the long-term effects of the EPI·NO training on recovery and pelvic floor muscle tone. The balloon is pumped up gently until the pointer on the pressure gauge reaches (4) and then fed into the vagina. Ten minutes of training every day are sufficient to restore strength to the muscles of the pelvic floor. The pointer on the pressure display deflects when the balloon is compressed. If I train with EPI·NO is it still helpful to massage the perineum? Yes. The EPI·NO has proven to be the most effective method avoiding injuries to the perineum, but perineum massage should nevertheless be additionally applied. If I train with EPI·NO is it still necessary to take part in a birth preparation course? Yes. A prenatal course under the supervision of a qualified midwife is useful and recommended. Are there any circumstances under which I should not use EPI·NO? You will find information on contraindications in the Instructions for Use. This information is also available from the EPI·NO web site at www.epi-no.com. If you are not sure whether you can use the EPI·NO please contact your physician for further information. Are EPI·NO Delphine/ Delphine Plus patented? Yes. The world wide patents of the unique EPI·NO balloon design are owned by Dr. Horkel (the inventor) and TECSANA. My friend is expecting a baby. Should I hand on my EPI·NO to her? No! As it is not possible to sterilize the EPI·NO Birth Trainer, it is recommended for personal use only! If I have further questions or wish to purchase EPI·NO, whom can I ask? Please contact your local Distributor or send us an email: teresa.gernon@epi-no.co.uk