Effect of Peanut Ball and Position Changes in Women Laboring With an Epidural

Abstract

ObjectiveTo examine the effect of a nurse-driven intervention using a peanut ball (PB) with position changes on length of labor and incidence of cesarean birth among women who receive epidural anesthesia. DesignQuasiexperimental comparison group design. Setting/Local ProblemA 407-bed, nonprofit, Magnet-designated, Baby-Friendly Hospital Initiative–designated hospital with 8 labor and delivery suites and an average of 100 births per month. ParticipantsA total of 343 participants were included, with 164 women in the PB group. Intervention/MeasurementsThe PB was placed after epidural administration; women were repositioned a minimum of every 1 to 2 hours, and the PB was removed at second stage of labor; duration was recorded. ResultsOverall, women in the PB group were 50% less likely to have cesarean birth. For women with cervical dilation of 4 cm or less, rates of vaginal birth were 61% with use of the peanut ball. A multivariate analysis of outcomes was used. A multiple linear regression model showed, after adjusting for other variables, that PB placement alone did not shorten labor length (p = .4684). However, a stratified analysis indicated that for women with cervical dilation of 4 cm or less, length of the first stage of labor was affected by parity (p = .0042) and frequency of position change (p < .001). For women with cervical dilation greater than 4 cm, length of the first stage of labor was influenced by frequency of position changes (p = .0130) and effacement (p = .0050). Length of the second state of labor was affected by the frequency of position change (p = .0416). ConclusionThe PB may be an effective intervention to reduce the incidence of cesarean birth. Changing position frequently was associated with reduced length of first and second stages of labor.