Improving labour progression among women with epidural anesthesia following use of a birthing ball: a review of recent literature

J Obstet Gynaecol. 2020 May;40(4):491-494. doi: 10.1080/01443615.2019.1633519. Epub 2019 Sep 3.


Epidural anaesthesia is an effective form of pain relief during vaginal deliveries. However, neuraxial anaesthesia may slow the progression of labour. The assumption that epidurals lead to increased caesarean sections is also a topic of current debate. A holistic approach with the use of a birthing ball has been advocated as a potential modality to decrease labouring times and, therefore, reduce progression to caesarean section. Birthing balls aim to increase pelvic outlet opening, which facilitates labouring. Our aim is to review recent literature pertaining to birthing balls and their role in improving quality and outcomes of vaginal deliveries in patients with epidurals.IMPACT STATEMENTWhat is already known on the subject? Epidural anaesthesia may slow the progression of labour. It has been hypothesised that slowing progression of labour is associated with increased rates of vacuum and forceps delivery. Most common clinical indication for caesarean section is failure to progress during labour. Birthing Balls have been shown to quicken the progression of labour, theoretically reducing caesarean sections with those with epidurals.What do the results of the study add? Several studies have demonstrated a reduced duration of first and second stage of labour among women with epidural anaesthesia, but the existing literature is limited, and interpretation of results may be restricted by generalizability and inherent study biases. The objective of this article is to review existing literature and highlight the potential clinical utility of birthing balls in current obstetric practice.What are the implications of these findings for clinical practice and further research? Use of birthing balls has been advocated to decrease labouring time and therefore reduce progression to caesarean section. Larger studies or meta-analysis would be required to confirm potential benefits of birthing ball use.

Keywords: Peanut ball; birthing ball; caesarean section; epidural; labour.

Publication types

  • Review

MeSH terms

  • Analgesia, Obstetrical* / adverse effects
  • Analgesia, Obstetrical* / methods
  • Anesthesia, Epidural* / adverse effects
  • Anesthesia, Epidural* / methods
  • Cesarean Section / methods
  • Cesarean Section / statistics & numerical data
  • Delivery, Obstetric / methods*
  • Dystocia* / chemically induced
  • Dystocia* / prevention & control
  • Female
  • Humans
  • Patient Positioning* / instrumentation
  • Patient Positioning* / methods
  • Pregnancy
  • Trial of Labor*