Birthing balls and peanut balls for labor pain, delivery duration, and mode of delivery: a meta-analysis of randomized controlled trials

Background To determine the effects of birthing balls and peanut balls on labor pain, duration of labor, and mode of delivery. Methods In this systematic review and meta-analysis, Cochrane Library, EMBASE, MEDLINE ( via PubMed), Scopus, and Web of Science were searched from their inception to December 25, 2024, with an updated search performed on November 10, 2025. Included studies were randomized controlled trials written in English that investigated the efficacy of birthing balls or peanut balls compared to no birthing balls or peanut balls in pregnant women with a singleton and cephalic fetus. Conference abstract, editorial, review, dissertation, thesis, and non-randomized controlled trials were excluded. Primary outcomes were labor pain and duration of labor, while the secondary outcome was mode of delivery. Results A total of 23 studies involving 3,192 participants were included. Relative to no birthing balls, birthing balls significantly alleviated labor pain (MD: −1.81; 95% CI [−2.38 to −1.23]), shortened the duration of the first (SMD: −0.86; −1.26 to −0.45) and second (MD: −17.00 min; −26.54 to −7.46) stages of labor, and reduced the incidence of cesarean delivery (RR: 0.51; 0.37 to 0.71). Peanut balls significantly shortened the duration of the first (SMD: −0.85; −1.25 to −0.46) and second (MD: −10.90 min; −21.11 to −0.70) stages of labor, compared to no peanut balls. No other significant results were observed. Some concerns were raised and the overall quality ranged from moderate to low. Conclusions Based on low- to moderate-quality evidence, birthing balls appear to be a potentially effective tool and may be considered by nurses and midwives to help alleviate labor pain and shorten the duration of the first and second stages of labor, thereby potentially reducing the likelihood of cesarean delivery. Low-quality evidence suggests that peanut balls could help shorten the duration of the first and second stages of labor. More well-designed studies are needed to verify the true and comparative effects of birthing and peanut balls.