No, I am not talking about those little, delicious, homemade peanut butter balls. You might have thought I was going to say that eating them would help nourish a woman in labor and help her breast milk production.
Nope. They don't do that and I'm not going to say that. The peanut ball I am talking about is used in labor. A study of it's use at an Arizona hospital found that it decreased the length of the first stage of labor by NINETY minutes for moms who had an epidural. It decreased the pushing stage by twenty three minutes, on average, for these same moms. 200 mothers who received epidural anesthesia were assigned to one of two groups. The mothers received their epidurals at around 4 - 5 cms. dilation. Labors for the mothers who used the peanut balls were faster, as described above. For every one centimeter beyond the 4.7 average centimeters the women were dilated when they entered the study, the length of labor was reduced by 35 minutes.
The study also found that the "peanut ball moms" were less likely to need vacuum extraction. The Cesarean rate for these moms was 13 percentage points less than for the moms who did not have the peanut ball.
The study concluded that using the peanut ball for women who had an epidural in labor significantly reduced the length of labor without adverse outcomes for the babies.
The ball was placed between the laboring mothers' legs when they were lying on their sides. One source of information suggested that one leg remain resting on the ball while the other leg was lying on the bed in a "butterfly" position. This should open the pelvis to one side. The mother can change to the opposite side or to another position every 20 to 30 minutes.
The ball worked by opening up the pelvis and allowing the baby to make the maneuvers required to descend through the pelvis and after that, the birth canal.
So, how does this affect breastfeeding? It's pretty simple. Lactation consultants have reported for years there is a correlation between the use of epidurals and problems with breastfeeding. Some problems are related to the use of IVs fluids required when an epidural is given. Edema of the breast and fluid overload of the baby can lead to latching or sucking problems. Pitocin is sometimes needed if epidural anesthesia leads to a slowdown of labor contractions. This medication is associated with greater pressure on the infant's head and cord. This can lead to issues with the cranial nerves which control the baby's ability to suck. Pitocin is also associated with increased jaundice, which can result in poor infant feeding. A cascading result is that the mother's breasts are not stimulated properly. Lactogenesis III can be delayed (the mature milk starts "coming in"). Use of the peanut ball helps prevent labor slowing down to the point where Pitocin is given.
The side effects of an epidural, or the additional interventions which it may lead to, can increase need for a Cesarean section. Women who have a Cesarean section are more likely to experience a delay in their transitional/mature milk coming in. This, along with the postpartum pain which goes with a C-section, is more likely to lead to supplementation. In turn, supplementation increases the chance the mother will stop breastfeeding because of problems with latching and/or milk supply. Furthermore, because antibiotics are given with the C-section, women are more likely to develop thrush and the accompanying pain. Many of these women give up without seeking the help of a lactation consultant. If the use of the peanut ball if the mother has an epidural minimizes the use of Cesarean section, then C-section related breastfeeding problems are avoided.
Therefore, the use of peanut balls for women with epidurals in labor should increase the chance of successful breastfeeding among these same women -- at least that is a reasonable conclusion. I would expect a study, if done, would confirm this.
Women who do not have an epidural should be able to benefit from the ball also. Some blogs by doulas or midwives attest to this. While these women tend to move about more, which is beneficial for the baby's descent, they also need to rest from time to time. The ball can be used for a variety of positions when the woman is active, and can be placed between her legs when she is in the bed resting -- just as is done with the epidural moms.
The use of peanut balls in labor is very new to many hospitals. Some nurses are not aware of it. Others are not aware of the study done on it. Because of this, it is possible that some nurses will discourage its use. Some may fear injury to the mother if her leg slips off onto the bed. In cases like this, the mother, her labor partner, and the nurse might work out a plan to minimize mother's leg slipping off the peanut ball. The partner can sit or stand near the mother, or simply be vigilant to her movements and intervene if the leg starts to slip.
There must be a balance between the benefits and the risks of any intervention (this includes using the epidural itself). Nothing is always perfectly safe -- including doing nothing. First of all, there were no reports in this study of any problems with the mothers' leg slipping off the peanut ball, or of any injuries to mother or baby with its use. Secondly, as one care provider suggested in an article, a towel or pillow could be rolled up and placed behind the mother's back, and also in a place which would prevent the ball from moving.
So, let's review: the use of the peanut ball has been shown to decrease the time of labor, the need for forceps delivery, and the need for C-sections -- all associated with potential, a sometimes serious, complications. There is no report of evidence that somehow a mother's leg could be injured. This chance would be further reduced by telling someone who is with the mother to stay nearby and, if her leg begins to slip, to stabilize the leg and contact the nurse for assistance with repositioning the mother and the ball. So, any theoretical chance of injury is further reduced. Finally, the mother can be told of the benefits and any potential risks, real or theoretical, of the use of the peanut ball, and then she can make an informed decision. This is done all day long and every day by patients and their care providers in the hospital setting.
A sturdy peanut ball that is not likely to leak or burst will cost around $50. A width of approximately 55 centimeters or approximately 20 inches was recommended for most women. Many hospitals do not have them yet, so you will probably need to bring your own. This $50 investment can be recouped many times over in a lower hospital bill and also by not having to switch to formula - - as long as no other problems arise which require a C-section or which lead to breastfeeding cessation. You can watch a YouTube video on how to use the peanut ball at
http://www.youtube.com/watch?v=hSn_BWjL1nw
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