The Use of a Peanut Ball During Labor in Nulliparous Term Singleton Vertex Pregnancies to Decrease the Primary Cesarean Rate: An Evidence-Based Practice Improvement Project

BACKGROUND: Current statistics indicate cesarean section rates in nulliparous term singleton vertex (NTSV) pregnancies, a singleton first pregnancy > 37 weeks’ gestation in a vertex position, of 32.8% and rising. A peanut ball, a tool used to optimize pelvic opening and fetal head rotation, can decrease labor length and cesarean section rates. The aim of this evidence-based practice improvement project was to reduce the cesarean rate in NTSV pregnancies by 1% within three months. The project occurred in an urban 12-bed labor and delivery unit in Middle Tennessee. Participants included laboring women meeting NTSV criteria. METHOD: Plan- do- study- act cycles were used, following Levin’s EBPI framework. Baseline NTSV cesarean rates were collected before implementation. Review of the literature identified labor support tools and staff education methods. INTERVENTION: Staff received education through a certified peanut ball instructor. Nurses’ knowledge of the peanut ball, frequency of use, and confidence using the peanut ball were measured before and after education. Data collection was performed through nurse reports using pre-formatted worksheets (N = 103). RESULTS: The hospital NTSV cesarean section rate rose by 2.6% from 24.7% to 27.3% over the project period, not meeting the 1% reduction aim. Eighty-seven women used the peanut ball during labor, 81.6% delivered vaginally, and 18.4% had a cesarean section. The use of the peanut ball in the project group did not have a significant change in the cesarean rate from the hospital rate (p = .072), but clinical significance cannot be disregarded. Nurses’ knowledge (p p = .018), and confidence using the peanut ball (p = .044) all significantly increased after education. CONCLUSION: The peanut ball is a valuable labor support tool that may reduce the risk of cesarean birth. Education poses significant benefits, including greater staff confidence, knowledge, and increased frequency of peanut ball use.