AHMC Anaheim Regional Medical Center “Peanut Ball” Intervention
to Reduce C-Sections among First Time Mothers
A cesarean birth (C-Section) is the surgical delivery of an infant through
incisions made in the mother’s abdomen and uterus. In the United
States, one in three infants is delivered by cesarean (also known as a
C-Section), or more than 1 million births annually.
A cesarean birth can be performed for many medical or personal reasons,
but it is important to realize that a cesarean presents increased medical
risks for both the mother and infant.
Possible risks from a cesarean birth (which are also associated with vaginal
- Blood loss
- Formation of blood clots in the legs, pelvic organs, or lungs
- Injury to the bowel or bladder
- Reaction to medication or anesthesia used
Among women who have one cesarean delivery, more than 90% will deliver
their subsequent pregnancies by cesarean. The more cesarean births a woman
has, the greater risk there is for problems with future pregnancies, including
problems with the placenta, the risk of uterine rupture, which can be
life threatening for the mother and her unborn child, hemorrhage, and
the need for hysterectomy (removal of the uterus) at the time of delivery.
AHMC Anaheim Regional Medical Center has developed the “Peanut-Ball”
(PB) intervention as an effort to reduce cesarean section rates among
first-time mothers. Current literature suggest that the Peanut Ball (PB)
is a safe, cost effective, and efficacious intervention for reducing cesarean
sections rates [C/S] and there is moderate evidence to support its use
amongst laboring women with epidurals. The benefits are two-fold; the
PB intervention decreases C-Section rates while shortening the second
stage of labor.
The main mechanism of action is thought to be the PB capacity to
widen the pelvic outlet in women who are already experiencing “pelvic floor relaxation (i.e.,
epidural side effect).”
AHMC Anaheim Regional Medical Center developed a policy and staff training
has occurred with the clinical shift manager team. The policy outlines
- Patient selection is strictly based on nursing assessment and judgment.
- To be utilized only during the first stage of labor and early second stage
to facilitate fetal descent (mainly with patients who have labor epidurals).
- Not to be utilized outside of bed by patients with intrathecal analgesia.
- PB size (40 cm, 45 cm, and 50 cm) varied based on patient BMI.
Since the introduction of the PB Intervention, it has proven to significantly
reduce the cesarean sections rate at ARMC. In the pilot phase, women in
who utilized the PB experienced a 5.5% cesarean rate while women who did
not utilize the PB experienced a 14% cesarean rate. Patients who utilized
the PB were
significantly less likely (2%) to experience a C/S in comparison to their NTSV counterparts
who did not utilize the PB as an intervention (8%), thus reinforcing the
benefits of the PB as a simple intervention to reduce C/S rates amongst
Currently, data does not exist on the second stage of labor length or group
comparison for similarity, but collection for these items will be added
to future statistical analyses.
Patients have verbalized
empowerment in the labor process when using the PB. Staff nurses and physicians alike
have shown a positive attitude and appreciation for the simple intervention
in decreasing C/S rates amongst our patients. Team effort and collaboration
was critical. System use of the PB at all AHMC perinatal facilities was
initiated with corporate support.