The peanut ball is an hourglass-shaped inflatable device used in labor and delivery, particularly for individuals confined to bed. Placed between the legs, it provides support and helps maintain an open pelvic position. Using the peanut ball facilitates the opening of the pelvis, which aids in the baby’s descent and rotation through the birth canal. It is commonly employed to assist labor progression, especially for those who have received an epidural or are experiencing fatigue.
The Mechanism: How the Peanut Ball Assists Labor
The effectiveness of the peanut ball is rooted in its ability to mimic the pelvic opening achieved during upright positions like standing or squatting, even when the laboring person is lying down. By supporting the upper leg and knee, the ball encourages the widening of the pelvic diameters across the inlet, midpelvis, and outlet, creating more space for the baby to navigate the birth path. The ball can promote either symmetrical or asymmetrical positioning. Asymmetrical positioning, where one leg is higher than the other, is particularly useful as it creates more room in the midpelvis for the baby to rotate and descend. The mechanical separation of the legs by the ball achieves the expansion of the pelvic structure, helping move the baby into an optimal position for birth.
Specific Positions for Active Labor and Pushing
Side-Lying Position
The side-lying position is the most common way to use the peanut ball and is effective for the first stage of labor when the baby is still higher in the pelvis. The laboring person lies on their side with the ball placed between the knees and thighs, ensuring the knees are slightly bent. The top leg rests comfortably over the ball, allowing the hips to be externally rotated and the pelvic inlet to open. A second person may need to assist in positioning the ball to ensure the knee and ankle are properly supported.
Asymmetrical Placement
A variation of the side-lying position involves asymmetrical placement, which targets the midpelvis. In this scenario, the top leg is draped over the ball while the lower leg rests straight on the bed. This creates a lunge-like effect while lying down, encouraging the baby to rotate and move past the ischial spines. Changing sides every 30 to 60 minutes is recommended to maintain circulation, promote symmetry, and encourage continued labor progress.
Semi-Reclined Position
The semi-reclined or Fowler’s position is another option, often used in active labor. The person is propped up in a semi-sitting position in bed, and the peanut ball is placed under one leg to support a lunge. One leg is extended over the ball, while the other leg remains bent to the side. This asymmetrical posture uses gravity to help the baby move lower while still allowing the laboring person to rest.
Pushing Phase
During the pushing phase, the ball is often used to open the pelvic outlet. This is achieved by transitioning to a tucked side-lying position, where the knees are brought closer to the chest with the ball still positioned between them. The ball supports one leg while pushing, and alternating the leg over the ball every few contractions is beneficial. This technique helps to widen the lowest part of the pelvis, giving the baby maximum space for the final descent.
Choosing the Right Size and Ensuring Safe Use
Selecting the correct size peanut ball is important for both effectiveness and comfort, as it is based on the laboring person’s height. For individuals under 5 feet 3 inches, a 40-centimeter ball is recommended. People between 5 feet 3 inches and 5 feet 6 inches typically find the 50-centimeter ball to be the most suitable size, while taller individuals (5 feet 7 inches or more) usually require a 60-centimeter ball.
Proper inflation of the ball is an important safety measure; it should be firm enough to provide support but still slightly pliable. Before using the ball, ensure it is securely positioned and will not slip or roll out from between the legs, which often requires the assistance of a birth partner or nurse. The person using the ball must be monitored for any signs of numbness, excessive pressure, or discomfort, and the position should be adjusted immediately if these occur. If the ball is too large, it can potentially stress the hip joint, so comfort and correct alignment are the best guides for safe use.