The EPI-NO Story

Dr Wilhelm Horkel 

Starnberg Obstetrician/Gynaecologist & EPI-NO Inventor 

I had long been concerned about Episiotomy, which was until recently a common procedure in Germany, performed routinely on first time mothers. I had become aware of the pain and discomfort this caused women, and had avoided this procedure in my Clinic at Starnberg unless the delivery made it unavoidable. Starnberg Clinic enjoyed a reputation for Natural Childbirth practice and followed closely the philosophy of Dr Le Boyer, a pioneer in this field.

Inspired by an African experience

I had the privilege in the mid 1980s to visit a German medical mission in Africa focused on addressing local Women’s Health issues. I became interested in a childbirth preparation practice, which was achieving better outcomes for the mother than the procedures followed in German hospitals at that time. Childbirth injuries to the mother, which resulted in infection, were potentially fatal in that environment, but were minimised by a routine of gradually stretching the perineum using a series of gourds of increasing size.

EPI-NO - developed with  Midwives 

I took this idea with me back to Germany and designed an inflatable silicone balloon of the dimensions required to stretch the perineum evenly. Coupled to a pressure display hand pump, I was able to recreate the effect of the graduated gourds. With the support of my staff of midwives we commenced a test of willing patients and experienced immediate and significant improvement in perineal outcomes. At a time when first time mothers in public hospitals could expect a 10% probability of an intact perineum, we achieved over 70% intact perineum rates for first time mothers at Starnberg Clinic. It was determined that not only did the stretching benefit the women, but the reduction in anxiety levels contributed to a more controlled, and shorter second stage of labour. The EPI-NO concept was born.

From Starnberg to over 20 countries

In 1999 after many successes and with over 1000 babies born each year at Starnberg, the company Tecsana (meaning 'Gentle Technology') was formed to develop EPI-NO in its next phase beyond Starnberg, to the wider German market, then to Switzerland and Austria, and now to over 20 countries.

There are many variables in the natural childbirth equation, - but one constant: 10 centimetres. EPI-NO is now helping women everywhere to more easily achieve this goal.


Dr Wilhelm Horkel
Starnberg Germany


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