Birthing ball exercises are one of the non-pharmacological methods for speeding the start of labour. Exercises with birth balls have the potential to reduce discomfort by relaxing muscles and improving blood flow to the uterus. This study aimed to determine the effectiveness of birth ball use on labour outcomes among primi mothers at a selected hospital in Salem. A quantitative research approach with a quasi-experimental post-test control group design was used. The sample size was 60; each 30 in the experimental group and control group were selected by using the non-probability purposive sampling technique. Written consent was obtained from the samples. A modified partograph was used to assess the labour outcomes. Both birth balls utilised in this study were found to affect labour outcomes. There were statistically positive correlations between the birth ball exercise effects on the progress of labour in terms of decreasing labour pain (z = 4.910 at p level of P<0.001), the highest effect on cervical dilatation (z =2.856 at p level of P<0.001), promoting normal modes of delivery (z = 4.538 at p level of P<0.001), and reducing the perineal tear (z = 3.693 at p level of P<0.001) in the experimental group group, while the control group showed less progress with highly statistically significant differences. Moreover, the control group expressed a higher pain score and perineal tear. This study revealed that the birth ball sitting helps to reduce the indensity of labour pain, promote cervical dilatation, and promote normal delivery.