(The writers' names have been changed for the purpose of anonymity)

From Tali, Oct 2006

Sarah,

What is your opinion about the "Epi No"? Do you have  any experience with it? 

Hi Tali,

I have been reading more and talking to midwife friends about epi-no since you wrote to ask me about it. The midwife who I work with extensively, Hilary Kirschenbaum, told me that if a woman comes into Soroka saying they used epi-no, they won't give her an episiotomy. She may tear, but they don't cut her. I know that a birth with her hardly ever tears, but not everyone is fortunate enough to get her on shift.

She (Hilary) recommends epi-no, and she sells them, too. Costs around 500NIS. I have never used one, or assisted someone using one. From what I read here: http://www.pelvicfloorexercise.com.au/products/epi-nodelphineplus.htm, it seems like a really effective exercise. What do you think?

Sarah,

I have asked my Dr about the epi-no and he said he would be afraid to insert something

external , and create infection. Also that there are types of skin color that will tear (GINGI or white...), and that there is not much one can do to avoid it.

Thanks.

Hi Tali,

I don't know the Dr but I can give my opinion about what he told you. The first point is true- the more something foreign is put into the vagina, the more you have a risk of infection. But if you wash it well each time, I consider this a low risk. Exposure to infection becomes high risk if you are dealing with a situation that amniotic water has been broken already- during labor. Now, in your stage, everything is sealed up and if you are careful, it is a reasonably low risk.

The other point, that you will tear anyway because of the gingy skin tone, I've heard before, but I also know that it is still possible to avoid a tear. I have helped women with normal sized & (very big) babies with gingy (light) skin tone, and if the proper technique is used, there will be no tear. It is almost always possible to avoid. I recommend perineal massage with Almond oil for a month before the due date.

Sarah,

My Dr recommends massage with tea oil.

I have started to do massage with almond oil and I must say it is hurts, like burning although I did it very gently and for less than a minute.

Hi Tali,

To do perineal massage, I recommend almond oil, with a little (a drop) of lavender oil into it. Tea tree oil is a bit rougher, although that isn't why it burned you. The burning is like the feeling of a baby crowning- you are stretching the perineum. But when the baby is crowning, there is an advantage of a natural anestesia that the body gives- the nerves in the vaginal opening during crowning get deadened after the first appearance of the baby's head, so the burning stops quickly. You can keep trying for a minute at a time a few times a day if you want. But, the risk of infection is the same- make sure your hands are very clean, and use generous amounts of oil. Some couples have the husband do it because it is an awkward place for a pregnant woman to reach comfortably, and it can create an opportunity for intimacy.

Question from Miriam: December 2006

Sarah,

Very suddenly, I started having pain in my lower abdomen. At first they were like mini-contractions and I was completely freaking out. Now, a week later, it seems that there is both pain and some tightening of my uterus, but only when I stand or walk. As soon as I sit or lie down the problem goes away.

I've been to the doctor twice and everything checks out -- there is thank G-d, no cervical shortening, fetus looks happy, the amount of fluid is fine, etc etc. She has no explanation for this pain but suggested I could try a maternity belt. Seems a little counterintuitive to me that a first-pregnancy should need one and I also vaguely remember learning that such a support structure could actually make the muscles weaker since then they don't need to work at all....but on the other hand the situation as is isn't particularly good. This whole thing is a mega-bummer...I am used to being quite physically active, and now even being on my feet for 5 minutes is a challenge.

Do you have any experience with these belt things? I think I'll call Yad Sarah tomorrow and see if by chance they have one to borrow since I'd rather try one out before I buy one.

Miriam,

I forgot what week you are in (middle of pregnancy, right? 23^rd week or so?). I'm glad your Dr. said everything looks OK.  You can always go for an 2nd opinion, also, if you still are confused about the feeling.
It does sound to me like a muscle thing. I think that way because it stops when you lie down. That is also symptomatic, of course, of Braxton Hicks contx- they feel very much like you describe- a tightening feeling in the belly- it feels like the belly is hard as rock when they are happening, but they are usually (not always) identified as being without pain, just discomfort. I have heard people describe BH contx as painful, but they always go away when you lie down or sit down. If you are past week 25 or so (I totally forgot where you are in the pregnancy- forgive me), BH contractions can start up, and for a first timer, it is unnerving. In general, I say to try to see it through without doing anything different- just resting more when possible (I know, not so easy), and noticing when they come that tightening feeling that accompanies it- it may help to put you at ease that it will pass. There are *many* wierd pains and stange-nesses that come during a pregnancy- especially the first. I remember asking my Dr. so many things; I was worried about abrupted placenta, or cord prolapse (I read the internet too much- too much time on my hands with the first pregnancy. :-) with all these strange things going on. At this point in life, I usually advise women to try to ride it out. Your uterus is stretching, ligaments are working overtime, muscles that were never challenged before have to rise to the occasion, and it takes time sometimes after the fetus has a growth spurt for the uterus & ligaments to catch up. That is often what hurts.

About the maternity belt- I have a lot of experience with it, unfortunately. I have a hernia that I acqired in my pregnancy with Shifra (3^rd pregnancy). It got worse with my pregnancy with Azriel (4th), and I still have to get it fixed sometime soon. Anyway, my pregnancies hurt a lot with this problem- the hernia is in the groin. Owie. I wore a big gertle- type thing with elastic blets that velcro under the belly as support. Only with that could I walk anywhere or function on my feet. It was a true lifesaver. I wore it *every day* for 5 months of my 3rd pregnancy, and 7 months of my 4th- hernia got worse, and started to bother me already in 2nd month. Joy. It was a good belt, though; it helped a lot. I recommend it if there is a hernia problem or a real need for it. Only use it if you feel like you cannot deal with this problem. I do recommend trying to ride it out a bit more first- the feeling may well change, and it'd be a pity to get used to this belt and then not know if you could've managed without it. Overall, it is better to do without it so the body can get strength whre it needs it. And, the thing costs over 300NIS, not covered by insurance, not attainable through Yad Sarah. And I threw mine out after my 4th birth- it gave it's all. :-)

There is the long & short of it. Good luck! I hope it goes away without the belt.