Peanut Balls for Labor - A Valuable Tool for Promoting Progress?

Today, Andrea Lythgoe, LCCE and doula, takes a look at the peanut ball as a tool for promoting labor progress for women resting in bed or with an epidural.  Many more facilities are making this new tool available to laboring women. Childbirth educators will benefit by understanding how to teach peanut ball use to families in the classroom and those professionals who attend births will want to know about the benefits and proper usage as well. Andrea shares the research that is available along with the personal perspectives of those who have used them firsthand. - Sharon Muza, Science & Sensibility Community Manager.


Most experienced peanut ball users recommend either the 45 cm or 55 cm sized peanut ball. The size is measured from the floor to the tallest point on one of the larger ends. Because it will be used between the legs to open up the pelvic outlet, you don't want it to be as large as the balls that are used for sitting and swaying. As I learned about the peanut ball, I found that many moms who did not like the peanut ball in labor felt it was too big. For this reason, I chose to purchase and use the 45 cm sized ball, which is the size used in the photos that accompany this article.

The peanut ball is most commonly used when mom needs to remain in the bed, whether because of epidural use, complications, or simply because mom is exhausted. There are two main ways in which peanut balls are used, with plenty of room for variation. The first is with mom in a semi reclined position, one leg over the ball, one leg to the side of the ball. The ball is pushed as close to mom's hips as is comfortable. As the ball can have a tendency to slide away from the mom, a rolled up towel can be used to hold it in place. This position seems to be most commonly used to promote dilation and descent with a well-positioned baby.

The second common use is with mom in a side-lying or semi-prone position, with the peanut ball being used to lift the upper leg and open the pelvic outlet. The ball can be angled so that the leg hooks around the narrower part, or aligned with both mom's knee and ankle resting on the ball. Mom's comfort level is key to knowing the right placement. Most women who used this position used it to help rotate a posterior baby to a more favorable position for delivery.


© Maternal Focus

The Research

There is not much research out there on the use of the peanut ball. In my search, I found one study, presented as a poster presentation at the 2011 AWHONN Convention. Tussey and Botsois (2011) randomized 200 women (uncomplicated labor with an epidural) into two groups. One group used the peanut ball in either the semi Fowler's position (bottom photos) or the sidelying position (top photos), switching sides every 1-2 hours. The sample size was small, but the results were very promising. The first stage of labor was shorter by an average of 90 minutes, and second stage was roughly half as long (43.5 min in the control group, 21.3 min in the peanut ball group). The use of vacuum and forceps was also lower in the peanut ball group. There were no serious adverse events reported in the study. This looks very promising, and I will be watching for more studies on the peanut ball in future years.

Many have speculated that the more upright semi Fowler's position might also be helpful in preventing the increase in operative deliveries seen with epidurals (Anim-Somuah (2011), but a recent Cochrane Review found insufficient evidence to demonstrate a clear effect. (Kemp, 2013) A similar review looking at the benefits of upright positions in moms without an epidural did show some benefit. (Gupta, 2012)

Since it is known that babies in an Occiput Posterior (OP) position can increase the length of second stage and the rate of operative delivery (Lieberman, 2013; Caseldine, 2013) the reports of posterior babies turning when the peanut ball is used may be a big reason for its effectiveness.

The Mother's Experience


© Maternal Focus

Jennifer Padilla, a mom who used the peanut ball in labor, described to me her experience with using the ball to rotate her posterior baby after 20 hours of labor. She had an epidural that did not take as well as she would have liked, and still found the peanut ball in the side lying position to be comfortable enough to take short naps. She said it took 1-2 hours with the peanut ball to rotate her baby, but that once the baby rotated to an anterior position, she was ready to push.

In preparing for this article, I read through over 30 online birth stories that included the peanut ball and noticed a few common themes:

Maternal Preferences and Positioning

Moms who were unmedicated preferred upright positions to the peanut ball nearly every time. Even when they used it and felt it was beneficial, the comments were not very positive. For example, one mom described it like this:

"Being positioned on the peanut ball was excruciating, I couldnt see straight and was howling in agony. I wanted to push it away and jump up but I could feel it working."

Moms with an epidural liked the peanut ball almost universally, except for a few instances where moms complained it "made their butt go numb" when using it in the semi-Fowler's position. Some commented that it was difficult to sleep when needing to switch the ball from side to side. Most moms described switching every 1-2 hours, some as frequently as every 20 minutes. (Women with epidurals usually switch side to side with the same frequency, even without the epidural.) One mom felt that using it semi-prone made her feel "undignified" and she wished her nurse had kept her covered with a sheet while lying in the position.

Some birth stories described moms leaning over the peanut ball, straddling the peanut ball, or using it in the shower in some capacity, but the vast majority used the ball in a side lying or semi prone position, with the reclined semi Fowlers a distant second.

Epidural Experiences

None of the moms who had an epidural reported any troubles with the epidurals losing effectiveness on one side while using the peanut ball, though several nurses I spoke with expressed concern that this would be a problem. More than a few moms who had an epidural said that they asked to stop using the peanut ball because of pressure in their back that turned out to be complete dilation.

Effect on Labor Progress

A few moms reported some pretty dramatic results:

A Doula's Perspective

I spoke with Heidi Thaden-Pierce, a doula and CBE in Denton, Texas. She has been using the peanut ball with her doula clients for a while now, and she says women are very receptive to the idea. Many of them have already discovered that sleeping on their sides with a stack of pillows between their knees is very comfortable. The peanut ball replicates this and doesn't slip and slide around as much as a stack of pillows can.

In her experience, most unmedicated moms will get up and get active in other positions over using the peanut ball, but "if a mom is needing some rest then we'll tuck her into bed with the peanut ball because it's comfortable and helps keep things in good alignment." She also will occasionally use it while mom is on the bed on all fours as a place to rest mom's upper body that is not as high as a regular birth ball. This can be nice if mom is more comfortable with her hips slightly higher than her shoulders.

Whenever I bring the ball to a hospital birth, I do explain what it is to the nurse and ask if there is any reason we should not use it. If a mom needs to labor in a certain position or there are concerns with the baby then I want to make sure that the peanut ball isn't going to be in the way. I think it's important that the mom's care team be aware of and comfortable with the use of the peanut ball, so I make sure we talk about it before we try it at the birth.

The L&D Nurse's Perspective

Carly Trythall, a nurse at the University of Utah Hospital in Salt Lake City, has worked with the peanut ball for labor in two different hospitals in her career as a nurse. She has mostly used the ball in the side lying position for helping to shorten labor. She said that most of her patients have been "accepting and eager" to try the ball and find it very comfortable. She finds that the ball is "most beneficial for moms who are not able to change positions frequently and utilize gravity (i.e. women with epidurals)."

The peanut balls are new to University Hospital; Carly was integral to introducing their use there, and she continues to work to educate patients and nurses about the balls and their use. Some providers have expressed a little resistance to their use, thinking it wouldn't be beneficial for moms, but as they have gained experience, that is changing.

The Childbirth Educator's Perspective - Teaching With The Peanut Ball

Because the effects of the peanut ball seem to be most pronounced in moms who use epidural anesthesia, teaching it in conjunction with epidural use seems the most logical. I teach techniques and support for moms with epidurals just after we learn the mechanics of an epidural and the benefits and risks of an epidural. This is where I recently integrated teaching about the peanut ball into my classes. Because I have a limited number of balls to work with (one peanut ball and one elliptical shaped ball of similar proportions) I can't have all the moms practicing with the ball at the same time. I break up the group into smaller groups of 2-3 moms and partners, and have the other groups working on other epidural support activities while each group has a chance to practice with the peanut. We allow enough time for every mom who wants to experience the 2 main positions with the peanut to try them. I warn them the week before to be sure they wear comfortable loose clothing that they will be able to freely move around in as we practice.We practice with mom trying out both of the main uses of the ball:

  1. Semi-sitting position (Semi Fowler's) with one leg over the birth ball and one leg open to the side. In the absence of a hospital bed in the classroom, I use a traditional birth ball or mom's partner sitting against the wall for moms to recline against as we practice this position.
  2. Side lying or semi prone with the peanut ball between the legs. We experiment with different positions to find a variation that is comfortable, reminding the parents that what they like now may not be the one they like in labor.

We also brainstorm possible ways to do these positions in the event there is not a peanut ball available.


Maternal Focus

Carly Trythall said that, as a nurse, she wished that women were learning more about the peanut ball in their classes: "I would like for moms to be taught the benefits of using a peanut ball during labor such as assisting with fetal rotation and descent by widening and opening the pelvis (great for OP babies), shortening the active phase of labor (because baby is in a more optimal position) and shortening the pushing phase of labor.


While there remains much to be learned about the efficacy and circumstances in which the peanut ball might be most useful, the peanut ball appears to be a promising technique for laboring women, in particular those who have a posterior baby and/or need to remain in bed. Teaching this technique in your childbirth class can help women go back to their care providers and birth places informed about another option that is becoming more and more widely available.

Are you teaching about peanut balls in your childbirth classes?  Are you seeing the balls in use in your communities?  Have you had personal experiences either as a birthing mother or a professional with the peanut balls?  Please share your experiences and information in the comments below so we can all learn about this new labor tool to help promote vaginal birth.- SM

To learn more about peanut balls:

My thanks to the University of Utah Labor and Delivery unit for the use of their room for the photos included in this article.


Anim-Somuah M, Smyth RMD, Jones L. (2011) Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD000331. DOI: 10.1002/14651858.CD000331.pub3

Carseldine, W. J., Phipps, H., Zawada, S. F., Campbell, N. T., Ludlow, J. P., Krishnan, S. Y. and De Vries, B. S. (2013), Does occiput posterior position in the second stage of labour increase the operative delivery rate?. Australian and New Zealand Journal of Obstetrics and Gynaecology, 53: 265270. doi: 10.1111/ajo.12041

Gupta JK, Hofmeyr GJ, Shehmar M. (2012) Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews, Issue 5. Art. No.: CD002006. DOI: 10.1002/14651858.CD002006.pub3

Kemp E, Kingswood CJ, Kibuka M, Thornton JG. (2013) Position in the second stage of labour for women with epidural anaesthesia. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD008070. DOI: 10.1002/14651858.CD008070.pub2.

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. (2013) Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews, Issue 10. Art. No.: CD003934. DOI: 10.1002/14651858.CD003934.pub4.

Lieberman, E, Davidson, K, Lee-Parritz, A, Shearer, E (2005) Changes in Fetal Position During Labor and Their Association With Epidural Analgesia. Obstetrics & Gynecology. 105(5, Part 1):974-982.

Overcoming the Challenges: Maternal Movement and Positioning to Facilitate Labor Progress.Zwelling, Elaine PHD, RN, LCCE, FACCE[Article] MCN, American Journal of Maternal Child Nursing. 35(2):72-78, March/April 2010.


Peanut Balls for Labor - A Valuable Tool for Promoting Progress?

April 8, 2014 07:00 AM by Deena H. Blumenfeld, ERYT, RPYT, LCCE, FACCE
Andrea, I love this article. I do talk about the peanut ball in my Confident Birthing classes, although they are tough to come by in labor. I use a large yoga bolster for my demo with additional pillows or blankets to give the appropriate dimensions as needed. Is there any research or information on using bolsters instead of a peanut ball? Since it has the same postural effect on the body, I would assume it would have the same effect in fetal rotation, etc.

Peanut Balls for Labor - A Valuable Tool for Promoting Progress?

April 9, 2014 07:00 AM by Ashley Rossi Lovell, LCCE
THANK YOU! This was a wonderful way to learn about a tool I knew very little about. Will be getting one of these pronto!!

Peanut Balls for Labor - A Valuable Tool for Promoting Progress?

April 9, 2014 07:00 AM by Emily Wannenburg, DNM,CPT,HBCE
As a non-practicing nurse midwife and a Certified Personal Trainer who works in Women's Health, Wellness, and Fitness, I use the peanut ball for a good number of my Birth Doula Clients because I know it works. It's true, it's not always comfortable...but it DOES work to open the pelvis whilst supporting the hip-knee-and-ankle joints. I agree with the author in regards to a smaller ball. The larger balls begin to place a torque in the lateral aspect during abduction of the hip joint and cause the mother to "guard" her hip instead of relax and open the hip/pelvis. As a side note, the peanut ball is also a useful tool for clients with balance issues as it only rolls side to side which helps with stability while still challenging their core strength, posture, and challenges the balance centers of the brain. Great article!

Peanut Balls for Labor - A Valuable Tool for Promoting Progress?

April 10, 2014 07:00 AM by Lindsey
Great article. Nope, I haven't been teaching about the peanut ball in my class... but our local hospitals have peanut balls handy thanks to my dear friend Tanashia. Whenever I have a client get an epidural we get a peanut ball too. ?

Peanut Balls for Labor - A Valuable Tool for Promoting Progress?

May 29, 2014 07:00 AM by Kenya, the Doula
Hi! Loved this article and decided to purchase the peanut ball to test it out. I was able to use it during prenatal visits with Moms to plan for positions of comfort in labor and I used it this past weekend with two births. In one, we used it to elevate one of Mom's knees that had been causing her pain and as support for her back while laboring in an upright position. At the other birth, we used it to support Mom's legs while she delivered baby in a side laying position. Her was just the right height for her to relax and rest between pushing; the pillows were too low and Mom did not feel good when lowering her leg that much. I'm excited to continue using it and learning new techniques. Thanks for this post!

Can you please tell me which peanut ball is used in

January 3, 2015 07:00 AM by Marisa
Can you please tell me which peanut ball is used in the photo? I'd like to buy it.

Hi Marisa! It's a 45 cm peanut ball by Aeromat.

January 4, 2015 07:00 AM by Andrea D. Lythgoe, LCCE
Hi Marisa! It's a 45 cm peanut ball by Aeromat.

When on an epidural, mama?s movement is restricted

January 13, 2015 07:00 AM by Epidural: My Opinion -
1) When on an epidural, mama?s movement is restricted. ?˙She can only lay down, and roll about half way to one side or the other. ?˙This restriction can interfere with baby?s decent into the vaginal canal. ?˙Here?s a link about how the use of peanut birth balls can help [?]

Nitrous Oxide Use During Labor - Protecting the ?Golden Hour

January 13, 2015 07:00 AM by 2015 Birth Trends in the U.S. -
include: - Nitrous Oxide Use During Labor - Protecting the ?Golden Hour? - Birth and Peanut Balls - Delayed Cord Clamping These practices are standard in birth center births, and have been for a [?]

Thank you!!!

January 30, 2015 07:00 AM by Marisa
Thank you!!!

I find them on Amazon - maybe

March 23, 2015 07:00 AM by Sharon Muza, BS, LCCE, FACCE, CD(DONA), BDT(DONA), CLE
I find them on Amazon - maybe you can contact Isokinetics directly about a wholesale or bulk order?

Hello, We are a hospital in Ca

March 23, 2015 07:00 AM by Teresa
Hello, We are a hospital in Canada and are trying to find somewhere to buy the peanut shaped birthing ball. I tried googling Aeromat, but could not find a vendor. Anyone know of a vendor in Canada or the US to purcahse these. thanks

I am a birth Doula in NC and first came across the peanut in the hospital.

April 8, 2015 07:00 AM by Heidi
I am a birth Doula in NC and first came across the peanut in the hospital. Not all the area hospitals are carrying them however. I have purchased 2 for my business.

I used the peanut boll with great success

April 29, 2015 07:00 AM by Heidi
I used the peanut boll with great success and I am teaching about the boll in my birthing classes.

L&D, everybody kept exclai

June 4, 2015 07:00 AM by Baby girl C?s birth story | the hopeful worrywart
L&D, everybody kept exclaiming over the peanut ball I?d brought for help with labor progress. Turns out they were talking about buying some to [?]

They have lots of resources available to laboring w

June 26, 2015 07:00 AM by 35 Week Bumpdate and Hospital Plans | Not My Bun in the Oven
risk). They have lots of resources available to laboring women such as birthing?˙balls, the newer peanut balls I?ve just been reading about, birthing stools, squat bars, etc. This all surprised me [?]

Thank you for the article. My

July 29, 2015 07:00 AM by Susan
Thank you for the article. My question has to do with clothing, how best to keep the woman feeling covered as much as she would like and how to keep things sanitary. All the models in these photos have their leggings on which is not what typically would be the case in labor. A woman with an epidural will have nothing on most likely. Do you recommend covering the ball in a clean sheet each time it's placed under mom's leg?

I do cover the peanut ball (or

July 29, 2015 07:00 AM by Sharon Muza, BS, LCCE, FACCE, CD(DONA), BDT(DONA), CLE
I do cover the peanut ball (or a regular birth ball, when the laboring person is using that) with a flat sheet or chux pad. These images were staged for the purpose of the article. Thanks for reading, Sharon.

peanut balls as a comfort

July 30, 2015 07:00 AM by Big Changes in Maternity Care 2010-15 | Transition to Parenthood
peanut balls as a comfort item / item to aid labor progress, particularly in late labor for a mom with an [?]

?ÿI was able to move to ge

September 30, 2015 07:00 AM by Introducing our Baby Girl | MegsFitness
?˙I was able to move to get comfortable in the hospital bed, and they offered me a ?peanut ball? to help position me so that labor could progress while allowing me to be comfortable enough [?]

it near my face. She also

October 31, 2015 07:00 AM by libby: welcome baby girl! | Give in to Babylust
it near my face. She also helped rotate me between resting?˙on my left and right, situating a peanut ball between my knees to accelerate dilation?the back and forth also kept the epidural medicine [?]

a peanut ball. These can be used in many of the

November 4, 2015 07:00 AM by Doula = Mary Poppins | Naomi Turiano Birth Doula
? a peanut ball. These can be used in many of the same ways that birth balls can be used, but also offer certain benefits to a mom with an epidural.˙ [?]

were one invention I could

January 15, 2016 07:00 AM by 5 Things Your L&D Nurse Wishes You Knew | THE TAPROOT DOULA PROJECT
were one invention I could choose that completely transformed my nursing practice, it would be the peanut ball.˙Research shows that use of a peanut ball during labor with an epidural can reduce the length [?]

though, are typically a bi

March 2, 2016 07:00 AM by What is a peanut ball for labor?
though, are typically a bit smaller ? I recommend 45 to 55 cm. Peanut balls are essentially used?˙between?˙the legs to open up the pelvic outlet; you don?t sit or sway on them, as you would [?]

Awesome Resource

January 25, 2017 02:14 AM by Kassie

Great information. As a OOH midwife peanuts balls are not widely used. I do educated hospital based birth women in my childbirth education classes. I feel educating the nurses about the benefits of the peanut ball with fetal rotation would be very helpful. Also, educating women to ask for the peanut ball when in labor will help. 

Peanut ball

March 22, 2017 09:46 AM by Katie Jackson

Before I had my last baby, I had never seen one of these balls. My midwife recommended one when I wanted to switch positions. I was feeling tired and needing a rest. I was laboring with pitocin, without an epidural and was exhausted from the work. I used the ball in a side lying position for maybe thirty minutes and I feel like it was helpful. I was able to be in a more restful position while keeping my pelvis open and allowing the baby to rotate into a more favorable position. 

NEW Peanut ball Articles and over 19 NEW Positions for peanut ball

September 16, 2017 04:44 AM by Cheri Beth Grant, RN, ICCE, CLE, ICD, CLD, BDT(DONA)

There are now several NEW peanut ball articles out since this was written. Also there are now over 19 NEW positions for the peanut ball to use during labor and birth. Make sure to use the correct size of peanut ball for your client depending on what position you use. Such as a 40 cm size peanut ball may be in the semi sitting lunge position but you might have to use a 50 cm peanut ball in the tuck position or side lying position. Also you may have to use the 60cm peanut ball for the fire hydrant position. Make sure to use the 70cmpeanut ball for the park bench position.  Make sure you know the internal and external position  for the peanut ball depending if the baby is above the inlet, or the midpelvis or the outlet there are different positions depending where the baby is. Love this article as it was a great start but now there is so much NEW information out there this needs to be updated. If you want to keep up on the latest research for the peanut balls Check out the latest research, articles and educational material to teach about peanut balls on this link

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