Epi-No should be tested in different obstetric settings until an evidence-based clinical decision can be made

Excerpt

We thank Ms. Cohain for her interest in our systematic review of the Epi-No birth trainer. However, we disagree with her statement about the rationale used (episiotomy as a confounding variable in both control and study groups) to justify the nonsignificant results on the efficacy of this device. We discussed the limitations of the studies included in the review, especially the lack of standardization of the professional experience in both groups and if any adjuvant techniques were (or were not) included in all experimental study arms [1]. Epi-No should be tested in different obstetric settings until a good level of evidence is provided to guide clinicians worldwide; our suggestions to achieve this goal are presented at the end of the review. Using an idea that is generally believed to be true without testing it may be a fallacy [2]. The adoption of any therapy should be based on good and accepted evidence. …