While it is often ideal for the laboring mother to be out of bed and moving around during labor, sometimes complications or her desire for an epidural prevents this. However, frequent position changes can still be done in moms who have the epidural, including various positions using a peanut ball. A peanut ball is a a peanut-shaped vinyl exercise ball that you may also find in a gym or physical therapy facility. Using them during childbirth has been shown to shorten the length of labor and pushing and reduce the need for cesarean delivery and operative vaginal delivery, as they assist in widening the pelvic diameter, thus easing fetal descent and positioning. 

The original study demonstrating the effectiveness of peanut balls was conducted at Banner Health in Phoenix and presented as a poster at the 2011 AWHONN Convention. 200 women with uncomplicated pregnancies and an epidural for pain relief participated in the study, and they were randomized to either use the peanut ball or not during labor. The study found that women who used the peanut ball experienced a decrease in the length of the first stage of labor by over 90 minutes and a second stage of labor that was 22.3 minutes shorter. Also, the c-section rate for the women who used peanut balls in the study was 13 percentage points lower than the rate for those who did not. The use of vacuum and forceps was also lower in the group that used the peanut balls. 

Peanut balls vary in size, but a 45 or 50 centimeter ball is sufficient for most patients. If a woman is short, she may opt for the 40 centimeter size, whereas a tall woman may find a 55 or 60 centimeter ball most comforting. 

Peanut balls can be used in a variety of ways during labor. The most common position is one where the patient is lying on her side with the peanut ball between her knees. One leg is resting over the ball and the other is slightly bent either underneath it or next to it. This method is helpful for opening the pelvic outlet and allowing the baby to descend into the birth canal. Another common method is used to rotate babies in the occiput posterior presentation into a more favorable position for delivery. In this position, the mother is in a side-lying or semi-prone position, and the peanut ball is used to elevate the upper leg, with the other leg wrapped around the side of the ball.

Peanut balls are slowly showing up in more Labor & Delivery units across the country, but the same concept of opening the pelvic outlet can still be accomplished even if one is not available. One possible alternative is rolling up several large towels or finding pillows and positioning them between the mother’s slightly bent knees while she is lying on her side. It can sometimes be difficult for the pillows and towels to remain in position and not slip out, so they should be frequently checked and readjusted. Another option is to use the bedside table to elevate the upper leg, while the bottom leg remains resting on the bed. The wheels of the table can slide under the bed and the table can be covered with sheets and positioned to hover over the bed in order for mom’s leg to lay over it.   

Anecdotally, in the last three births where I’ve used the peanut ball with my doula clients, each of them being first time moms with epidurals, they pushed for 10 minutes, 35 minutes and 15 minutes. Of course, those numbers are not typical and should not be expected. In my experience with the peanut ball, the baby is usually very low in the pelvis when it is time to begin pushing, perhaps due in part to the fact that the opening of the pelvic outlet with the assistance from the peanut ball allowed the baby to more effectively descend.

If you have hired a doula for labor support, it may be worth asking if she owns one or is familiar with its’ benefits. Similarly, consider calling the hospital where you plan to deliver or asking your doctor or midwife if the hospital has peanut balls available for use during labor.