Everything you ever wanted to know about Peanut balls and more!
Have you heard about using peanut balls in labor?
They are a favorite in the birth world and with evidence based reasons! Most hospitals and birth centers have peanut balls and, as a doula, I always carry a deflated one in my doula bag, just in case there is not one available for my client. Many people assume that they are only used when a person chooses an epidural during labor but many clients use them in unmedicated birth, too! We’ll go over a number of positions and also some tips to make the birthing AND support person’s life easier!
When it’s time to use it, I just go into the bathroom, pull out my tiny, yet mighty favorite pump! It’s so small, it fits in the palm of your hand! It’s great for your birth bag, it’s quiet and has a little night lite on it, too!! Crazy, right?!
The original ball was called The Pezzi Ball and was created in the early 1960s by Aquilino Cosan, who produced toys in Italy. The round ball was originally developed as a ball to be used in gymnastics and physical fitness in Europe. In the 1980’s, American physiotherapists brought the ball to the use for stability training. In the 90’s, it became popular in the fitness industry and in the early 2000’s, it was showing up in childbirth education classes. The ball changed shapes over time into the egg shape that is commonly seen in the birth venue today and this shape allows for perfect support of the legs without the legs falling or sliding off of the ball.
What do you need to know about the Peanut Ball?
Sizing: The peanut ball comes in a number of sizes and has a weight limit of 400 pounds (according to the Milliard Company). My favorite size is the blue, 40 cm size from Milliard because I find that it can be used for every body size in labor. Unlike the birth ball (where larger is better than too small), the peanut ball is better to be too small than too large. This is particularly important to be aware of when working with an epiduralized client who is unable to feel what is happening with her hips. Hyper-abducting (making too wide) the legs can cause injury to to the hip capsule. If you find the the ball isn’t large enough, it’s very easy to place a pillow underneath to make the diameter between the legs larger.
Graphic from Milliard
What are the benefits to using the peanut Ball?
There are many evidence based studies regarding the benefits to using a peanut ball in labor (that alone is a long blog post in itself). The most important goal in labor is PROGRESSION. The number one reason for cesarean birth in the United States is “labor dystocia” or “failure to progress”. Mobility is a key element in the successful progression of labor and when an epidural is placed, mobility is limited. Using the peanut ball to aid in the opening of the levels (stations) of the pelvis is a game changer. Try the positions below to improve the progression of labor!
So… How do you use the Peanut Ball?
Look at the quote below. If you remember this saying, you will remember how to place the legs of your client while they are laboring. If you want to position your client to open the INLET of the pelvis, place her with her feet together and her knees wide. If you want to open the outlet of the pelvis, place her in positions where her feet are wider than her knees. For more on this, check out this blog
“Feet IN opens the INLET,
Feet OUT opens the OUTLET”
Here are my favorite ways to use the ball
These are appropriate for both medicated and unmedicated clients.
1) Side lying to open the inlet of the pelvis (below).
For clients in side-lying, placing a pillow behind their backs helps them stay in place, lift the bed pad (chux) and place the pillow under the pad. It keeps your pillow clean and also keeps it in place.
2) Side lying to open the outlet of the pelvis (below).
I like to place a pillow between the knees to help prevent pressure injuries.
3) Sitting upright to open the Inlet of the pelvis.
This position also allows for a support person to sit at the bottom of the bed and roll the peanut back and forth to make minor but still useful and important shifts in the pelvis
4) Sitting upright with knees together to open the outlet.
The ball supports the legs. For clients with an epidural, you can tuck the sheet in around the knees to help her legs stay in place ( as shown below).
5) Hands and Knees using the Cub for upper body support with feet placed in station appropriate position.
We know that forward leaning positions are helpful to the progression of labor because it encourages an anterior position of the fetal back. This position can be hard to maintain when an epidural is in place and I use a combination of the CUB and peanut ball to keep my clients in place. I use the sheet to wedge the peanut ball in place (as seen below marked by the yellow arrow). The works really well.
6) Fire Hydrant for asynclitic or posterior fetal head.
This can be done with both unmedicated and medicated / epiduralized clients. The ball can be place in alignment with the hip or forward of the hip for an OP baby.
What about cleaning the ball?
When I am using the ball, I will place a chux or bed pad between my client’s body and the ball to absorb and amniotic fluid or vaginal discharge. After use, simply take a sanitizing wipe or wash with soap and water, allow to air dry. If I am in the hospital, I will sometimes store it in a clear plastic bag after cleaning. (Doula Tip: I write my name on the ball so that it doesn’t get confused with the hospital balls)
Disclosure: There are amazon affiliate links in this blog post but I only ever link items that I love and use.
Resources:
Esegbona, G CS 2021 Abstract #104 The impact of external hip rotation during pushing
Hickey, L., & Savage, J. (2019). Effect of peanut ball and position changes in women laboring with an epidural. Nursing for women's health, 23(3), 245-252.
Honaker, M. E. (2021). The Use of a Peanut Ball During Labor in Nulliparous Term Singleton Vertex Pregnancies to Decrease the Primary Cesarean Rate: An Evidence-Based Practice Improvement Project.
Klump, J. S. (2017). Use of the Peanut Ball to Reduce Cesarean Rate.
Stulz, V., Campbell, D., Yin, B., Al Omari, W., Burr, R., Reilly, H., & Lawson, K. (2018). Using a peanut ball during labour versus not using a peanut ball during labour for women using an epidural: study protocol for a randomised controlled pilot study. Pilot and feasibility studies, 4(1), 1-10.