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Decrease the Length of Labor with the Use of a Labor Ball with Patients That Receive An Epidural

Sunday, June 26, 2011
Christina Tussey, MSN, CNS, RNC-, OB, RNC-MNN , Women and Infant Services, Banner Good Samaritan Hospital, Phoenix, AZ
Emily Botsios, BSN , Women and Infant Services, Banner Good Samaritan Hospital, Phoenix, AZ

Discipline: Childbearing (CB), Advanced Practice (AP)

Learning Objectives:
  1. Review the Friedman labor curve and the impact of the current use of the labor epidural
  2. List the risk, benefits, and side-effects of epidural anesthesia from a literature review
  3. Name some non-pharmacological methods to help progress a patient in labor that has an epidural

Submission Description:





It has been hypothesized that a laboring patient after receiving an epidural and using the exercise ball ( peanut ball) placed between a laboring patient legs) as compared to standard nursing care, may provide a shorter first and second stage labor and result in fewer operative deliveries.


A  randomized, controlled trial.


 At a large tertiary obstetrical facility


Patients included were singleton women in labor and received an epidural for labor discomfort except for those that received a magnesium sulfate infusion.


The women in both groups would turn their patients every 1-2 hours from side to side or semi-fowler. The peanut ball would be applied between the patient’s legs after the patient received the epidural. The control would utilize the time the epidural was placed as the start of monitoring the patient participating in the study  


The randomization assigned 200 laboring women to either the peanut ball ( 107) or no peanut ball being utilized ( 93). The primary outcome was the PB had a first stage labor time of 258.8 minutes and the control had 341.9 minutes, difference of 90 minutes (0.006).  The PB group had a 21.3 minute second stage and the control had a  43.5 minute a difference of 22.3 minutes, The use of the vacuum was 9.7 in the control and 6.7 with use of the PB.  The use of the forceps the control was 2.2 and the PB was 1.9.  The secondary outcomes included maternal age gestational age of fetus, weight of newborn, augmentation of labor with oxytocin; did not differ significantly between the two groups. Wit one exception the PB group had a cervical dilation that was 4.7 cm versus the control 4.2 cm at the start of the study. For every 1 cm more dilated the patient presented upon enrollment into the study the labor was reduced by 35 minutes. Total oxytocin time extended the length of first and second stage labor.  No serious adverse events associated with use of the PB were reported. Every one hour oxytocin used increased pushing time 1.2 minutes.  Length of pushing was variable with the use of oxytocin or parity.

Conclusion/Implications for nursing practice:

The use of the PB during labor for patient with an epidural, as compared with standard nursing intervention, did significantly reduce the length of labor, without adverse neonatal outcomes


Peanut Ball, Epidural, Labor, Labor Ball