Peanut Balls and VBAC Bans
Friday, September 9, 2011 at 7:26AM
By Jill Arnold
Banner Health, the largest hospital chain in Arizona, is promoting its new “peanut ball” program as an alternative to cesareans in women laboring with epidurals. Their press release credits nurses “seeking to curb rising Caesarean-section rates at hospitals nationwide” who “learned through experimentation that peanut balls could provide a natural alternative to more invasive birthing techniques such as C-sections or vacuum pumps,” according to this article in the Arizona Republic.
The Arizona Republic reports that a small trial was conducted at Banner Good Samaritan Medical Center:
“We are always looking for innovative ways to have the best outcomes for our patients,” said Christina Tussey, a clinical-nurse specialist at Banner Good Samaritan Medical Center. “We always ask our nurses to ask if there is a better way.”
After receiving anecdotal reports that nurses who used the peanut balls with expectant mothers had positive results, Tussey decided to test the idea.
The ball is used on women who receive epidural injections to alleviate pain during pregnancy. These women cannot use other proven birthing methods such as squatting or using an exercise ball.
The peanut-shaped ball fits comfortably between the patients’ legs, opening their pelvis to create a path for the newborn.
Tussey reviewed the concept with the hospital’s review board that vets such clinical trials. Then they recruited two groups of patients to test the theory - those who would be given peanut balls during appropriate stages of labor and those without.
Banner Health’s web site describes their trial:
The use of peanut balls was pioneered at Banner Good Samaritan Medical Center and has been rolled out to other Banner facilities. The Banner Good Samaritan trial included 200 pregnant women who were carrying a term baby and who had an epidural.
Banner Good Samaritan maternity staff investigated the use of peanut balls because research shows that while epidurals may reduce pain, they prolong labor by an average of 40 to 90 minutes and increase the risk of lengthening second stage labor (pushing) to more than two hours. In addition, epidurals are associated with higher numbers of births by cesarean section and more instrument-assisted vaginal deliveries, including the use of a vacuum or forceps.
Research also shows that varying a mother’s position and separating her legs during labor widens pelvic diameter. Doing so helps ease fetal rotation and/or descent while reducing some of the pain of prolonged labor.
Women with peanut balls placed between their legs experienced increased pelvic diameter and, in turn, had more room for the fetus to descend.
Peanut balls cost $40 and have been shipped to all of the chain’s hospitals with maternity services and the behest of Banner Health’s clinical-performance director for obstetrics.
The Arizona Republic reports both number of births and rate of cesarean delivery at Banner Health hospitals:
About 30,000 babies are born at Banner Health hospitals in Arizona, Colorado and other states, and Banner’s C-section rate is on par with the national average of 30 percent.
The Phoenix-based hospital system expects the peanut ball is among the ways the hospital system will seek to lower the C-section rates.
Another way that Banner Health could lower cesarean rates, if that is an administrative goal, is to ensure that vaginal birth after cesarean is allowed in all hospitals offering maternity services. The following list pairs all hospitals listed on Banner Health’s Maternity Services page with data from the International Cesarean Awareness Network (ICAN) VBAC Policy Database.
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Facility |
VBAC Banned? |
Direct link to ICAN site |
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Alaska |
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Allowed |
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Arizona |
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Not listed |
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Banned |
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Allowed |
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De Facto Ban |
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Not listed |
Not listed |
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Allowed |
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Not listed |
Not listed |
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Not listed |
Not listed |
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California |
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Not listed |
Not listed |
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Colorado |
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Allowed |
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Allowed |
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De Facto Ban |
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Nebraska |
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Banned |
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Nevada |
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Not listed |
Not listed |
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Wyoming |
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Allowed |
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Banned |
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Banned |
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Not listed on the main Banner Health Maternity Services page is Page Hospital in Page, Arizona, which also offers maternity services according to its site. Page Hospital made national news in 2009 for threatening a woman with a court-ordered cesarean.
Joy Szabo Made Some Noise about a VBAC Ban, CNN Listened
Page Hospital in Arizona Threatens Woman with Court-Ordered Cesarean
Reader Comments (4)
"Research also shows that varying a mother’s position and separating her legs during labor widens pelvic diameter. Doing so helps ease fetal rotation and/or descent while reducing some of the pain of prolonged labor."
And then they concluded that the answer was buying peanut balls....not just letting women move around if they want to.
From the Youtube video demonstration (demonstrator is fully clothed) that I found, it seems like a way to get around the whole immobility problem caused by epidurals without actually getting rid of epidurals or letting women get off the damn bed. Which is fine for women who want or need epidurals.
As a doula in Arizona, I have attended VBACs at Banner Gateway. One of our area's must VBAC-supportive OBs catches at Gateway.
While it frustrates me that they seem to think that this is a better idea that supporting VBACs, alternate forms of pain relief, and movement in labor, I guess I'm glad that they have another option to help women...? One handed clap? :)
Strange, I was originally supposed to deliver at Banner Del Webb. Switched to a VBAC friendly doc at 30 weeks and delivered at Banner Good Sam. Must have been before this was started or something, because it was not offered. Maybe it would have helped with my ~2 hr pushing stage?