Investigation of the effects of peanut ball during labor: An updated systematic review and meta-analysis.

Introduction: Peanut balls, a specific type of positioning aid used during labor, have gained attention for their potential to enhance maternal comfort and facilitate fetal positioning. This meta-analysis aims to evaluate the effect of peanut balls on the duration of the first stage of labor, the rate of cesarean section, and maternal satisfaction.

Methods: A comprehensive literature search was carried out employing electronic databases such as PubMed, Web of Science, and the Cochrane Library. The search included articles published from inception to 11 October 2023 with no language restrictions. Randomized controlled trials or quasi-experimental studies were considered for inclusion if they met the following criteria: participants were pregnant women in labor; intervention involved using a peanut ball during labor; and primary outcome included duration of labor, and the rate of cesarean section and maternal satisfaction were secondary outcomes. The risk of bias in the included studies was assessed using the Risk of Bias 2 (RoB2) tool. Results were synthesized using Review Manager software (RevMan version 5.1), employing both fixed-effect and random-effects models as appropriate, and results were presented as risk ratios for dichotomous outcomes and mean differences and standardized mean differences for continuous outcomes. The quality of the evidence was assessed using GRADEpro GDT (Guideline Development Tool).

Results: Eight studies including 1352 laboring women met the criteria to be included in the systematic review and meta-analysis. The results of the meta-analysis showed that the women with epidural analgesia who used the peanut ball, experienced a shortened duration of the first stage of labor by 52.98 min, which was statistically significant (p=0.003). Heterogeneity evidence was not found among the included studies (χ²=6.83, p=0.15, I2=41%). It was also shown that the risk ratio of cesarean section in women who used peanut balls during childbirth was significantly lower than the control group (RR=0.74; 95% CI: 0.60-0.91, p=0.0004) (χ²=5.72, p=0.45, I2=0%). Compared to the control group, the women in the peanut ball group were found to have a higher satisfaction level, which was statistically significant (p<0.0001).

Conclusions: The peanut birth ball reduces the first stage of labor duration, and lowers cesarean rates in women with epidural analgesia. While effective and non-invasive, the findings are limited by the risk of bias in some included studies.