Prospective randomised multicentre trial with the birth trainer EPI-NO® for the prevention of perineal trauma


: Dr Eugen Ruckhäberle, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. Email:


Background: In several non-randomised trials training with EPI-NO® increased the rate of intact perineum and decreased episiotomy rates, shortened the second stage of labour and lowered use of pain killers.

Aims: To verify the preliminary results with EPI-NO® in a prospective randomised trial.

Methods: Randomised, single-blind multicentre trial in four university hospitals in Germany including 276 primigravidae.

Results: After training with EPI-NO® we observed a significant increase in the incidence of intact perineum (37.4% vs 25.7%; P = 0.05) and a tendency towards lower episiotomy rates (41.9% vs 50.5%; P = 0.11). We found no significant differences between the two groups regarding incidence of perineal tears, duration of second stage of labour, use of pain relief and rate of vaginal infection.

Conclusions: Training with EPI-NO® increases significantly the likelihood of having an intact perineum and reduces the episiotomy rate.