Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
Division of Midwifery, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
Am J Obstet Gynecol. 2023 May;228(5S):S1270-S1273. doi: 10.1016/j.ajog.2023.02.014. Epub 2023 Mar 21.
Birthing balls and peanut balls have been used for decades by nurses and midwives as a nonpharmacologic adjunct to labor management based on anecdotal evidence. This article aimed to review the evidence regarding their safety and efficacy based on randomized controlled trials. Birthing balls are round exercise balls that a laboring individual can use for sitting, rocking, and pelvic rotation. The use of the birthing balls has been thought to increase maternal comfort and mimic upright positioning to widen the pelvic outlet for those laboring without an epidural. A recent meta-analysis showed that the use of the birthing ball in labor significantly reduces maternal pain in labor by 1.7 points on a standard visual analog scale of 1 to 10 (mean difference, -1.70 points; 95% confidence interval, -2.20 to -1.20). The use of the birthing ball does not significantly affect the mode of delivery or the rate of other obstetrical complications. This suggests that its use is safe and can offer subjective improvement in maternal pain experienced during labor. The peanut ball is a peanut-shaped plastic ball placed between the knees of a person laboring in the lateral recumbent position, a position common in those laboring with an epidural. Traditionally, its use has been thought to allow for bent-knee positioning that can mimic a squatting position and facilitate frequent and optimal position changes during labor. Data regarding the effects of the peanut ball are mixed. A recent systematic review and meta-analysis found that the use of the peanut ball compared with no peanut ball is associated with a significantly decreased first stage of labor (mean difference, -87.42 minutes; 95% confidence interval, -94.49 to -80.34) and an 11% higher relative risk of vaginal delivery (relative risk, 1.11; 95% confidence interval, 1.02-1.22; n=669). The use of the peanut ball is not associated with increased incidences of obstetrical complications. As such, it is reasonable to offer to individuals in labor. There has been no reported risk of the use of either the birthing ball or the peanut ball. As such, both interventions can be offered to individuals in labor as an adjunct to labor management techniques based on moderate quality evidence.
分娩球和花生球已被护士和助产士使用了几十年，作为基于轶事证据的分娩管理的非药物辅助手段。本文旨在根据随机对照试验，综述其安全性和有效性的证据。分娩球是一种圆形的运动球，产妇可以用来坐、摇、转动骨盆。使用分娩球被认为可以增加产妇的舒适度，并模拟直立姿势，为未使用硬膜外麻醉的产妇扩大骨盆出口。最近的一项荟萃分析显示，在分娩时使用分娩球可显著降低产妇的疼痛程度，在 1 到 10 的标准视觉模拟评分上降低 1.7 分（平均差异，-1.70 分；95%置信区间，-2.20 到-1.20）。使用分娩球不会显著影响分娩方式或其他产科并发症的发生率。这表明它的使用是安全的，可以为产妇在分娩过程中经历的主观疼痛提供改善。花生球是一种花生形状的塑料球，放在侧卧分娩产妇的膝盖之间，这是硬膜外麻醉产妇常见的姿势。传统上，它的使用被认为可以允许屈膝定位，模仿蹲姿，并在分娩过程中促进频繁和最佳的体位变化。关于花生球效果的数据喜忧参半。最近的一项系统评价和荟萃分析发现，与不使用花生球相比，使用花生球与第一产程明显缩短（平均差异，-87.42 分钟；95%置信区间，-94.49 到-80.34）和阴道分娩的相对风险增加 11%（相对风险，1.11；95%置信区间，1.02-1.22；n=669）。使用花生球与产科并发症发生率增加无关。因此，向产妇提供这种球是合理的。使用分娩球或花生球都没有报道有风险。因此，在基于中等质量证据的分娩管理技术中，可以向产妇提供这两种干预措施。
