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Am Fam Physician. 2024;109(4):367-368

Author disclosure: No relevant financial relationships.

Clinical Question

Does the use of a peanut ball in pregnant patients with an epidural improve labor outcomes?

Evidence-Based Answer

In pregnant patients laboring with epidural anesthesia, the use of a peanut ball with regular position changes decreases the duration of first-stage labor by 87 minutes compared with usual care (Figure 1). (Strength of Recommendation [SOR]: A, meta-analysis of randomized controlled trials [RCTs].) The effect may be more pronounced in primiparous patients. (SOR: B, single RCT.) A patient safety bundle that includes several improvements in labor support, including the use of a peanut ball, is associated with a reduction in cesarean deliveries. (SOR: B, cross-sectional cohort study.)

Evidence Summary

A 2022 systematic review and meta-analysis of four randomized or quasirandomized clinical trials (n = 818) compared the effect of using a peanut ball with usual care for laboring patients with epidural analgesia.1 In the intervention groups, researchers encouraged primiparous and multiparous patients 18 to 35 years of age with a singleton fetus in vertex position to use a peanut ball soon after epidural placement for at least 15 minutes every hour until reaching full cervical dilation. Patients changed position every 0.5 to 2 hours while using the peanut ball. Compared with patients receiving usual care, those laboring with a peanut ball had a shorter first stage of labor (two trials; n = 272; mean difference [MD] = 87.5 minutes; 95% CI, 80.3 to 94.5; high-certainty evidence based on the GRADE system) and a shorter second stage of labor (one trial; n = 201; MD = 22.2 minutes; 95% CI, 20.8 to 23.5; moderate-certainty evidence). The use of a peanut ball as a single intervention did not significantly change the risk of cesarean delivery (three trials; n = 669; relative risk = 0.75; 95% CI, 0.57 to 1.00; low-certainty evidence).

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Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (

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