What participants did you enrol in the study?

Pregnant women admitted to the maternity hospital.

The women could be of any parity. They had to be aged ≥ 18 years, in the active phase of labour (cervical dilation ≥ 6 cm), with a single pregnancy, at ≥ 37 gestational weeks, with the foetus in cephalic presentation and at low gestational risk.

Can you tell us a bit more about the peanut ball protocol that you tested?

The postures in the peanut ball were oriented according to the foetal location in the maternal pelvis (inlet/superior strait, midplane and outlet).

We also considered cervical dilation, the presence of pushing and maternal comfort.

In the inlet plane (superior strait) we encouraged exercises with the hip in the abduction and external rotation.

In the outlet plane (inferior strait) we encouraged exercises with the hip in abduction and internal rotation.

The postures used with the peanut ball were biped, semi-sitting, lateral decubitus, quadruped and sitting on the ball.

What did the control group receive?

Control group participants continued with routine maternity hospital care, in which a peanut ball was not included.

Assistance provided by the maternity hospital professionals was not provided systematically so, depending on the assistance team, parturients were encouraged to some extent to use non-pharmacological resources.

Generally, they remained lying in bed and were free to carry out any activity.

What outcomes did you measure?

Duration of labour, maternal pain, maternal fatigue, maternal obstetric outcomes (mode of delivery, perineal laceration, the presence of laceration or episiotomy), neonatal outcomes (Apgar score, admission of the neonate to an intensive care unit and resuscitation) and satisfaction with childbirth.

To what extent did the peanut ball protocol affect those outcomes?

The peanut ball protocol showed several benefits.

It shortened the duration of labour to a clinically worthwhile extent and shortened the active phase of labour to a similar degree.

This was accompanied by a small increase in the parturient women’s satisfaction with childbirth.

The experimental protocol was at least as good as—and maybe better than—the control intervention at shortening the expulsive phase of labour and reducing the risk of caesarean delivery.

Furthermore, these benefits were achieved with no deterioration in the severity of pain or fatigue between groups.

Where does research in this area need to progress now?

Future studies with high methodological criteria are encouraged to explore the effect of the peanut ball with different positioning and pelvic mobility in parturients without analgesia on maternal and neonatal outcomes.

In addition to creating new protocols with the association of the peanut ball together with other non-pharmacological resources.

>> Ana Carolina Rodarti Pitangui PT PhD is an associate professor at the University of Pernambuco, Brazil.
Within the physiotherapy department, she is a part of the Postgraduate Program in Rehabilitation and Functional Performance. She specialises in women’s health physiotherapy.

Course of interest:

Women’s Health Through The Life Stages Level 1—Part B