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The Somatic Connection  |   July 2018
Reducing Cesarean Delivery Rates and Length of Labor by Addressing Pelvic Shape
Author Notes
  • Western University of Health Sciences College of Osteopathic of the Pacific-Northwest, Lebanon, Oregon 
Article Information
The Somatic Connection   |   July 2018
Reducing Cesarean Delivery Rates and Length of Labor by Addressing Pelvic Shape
The Journal of the American Osteopathic Association, July 2018, Vol. 118, 489-490. doi:https://doi.org/10.7556/jaoa.2018.110
The Journal of the American Osteopathic Association, July 2018, Vol. 118, 489-490. doi:https://doi.org/10.7556/jaoa.2018.110
Tussey CM, Botsios E, Gerkin RD, Kelly LA, Gamez J, Mensik J. Reducing length of labor and cesarean surgery rate using a peanut ball for women laboring with an epidural. J Perinat Educ. 2015;24(1):16-24. doi:10.1891/1058-1243.21.1.16 
Although cesarean delivery rates are declining, approximately one-third of all expectant US mothers deliver via cesarean. In 2015, the cesarean delivery rate was 32%.1 The most common reason for a cesarean delivery in mothers with no previous cesarean deliveries and singleton vertex fetuses is lack of progress in labor. This diagnosis covers several causes, including fetopelvic disproportion, prolonged labor, and arrest of dilation.2 
A randomized controlled study was designed and conducted to focus on the mechanical aspects of labor. The study's aim was to evaluate the effects of the peanut ball in labor time and rate of spontaneous vaginal births. The peanut ball is an intervention intended to widen the pelvis and optimally position the fetus in relation to the pelvis. Women who met the inclusion criteria (active labor, use of epidural, cephalic presentation) were randomly assigned to the peanut ball (n=107) or control group (n=94). Standard care was given to both groups. The peanut ball was placed between the laboring women's legs in the test group immediately after receiving the epidural and remained in place until the cervix was completely dilated and effaced, passive descent was complete, and the woman was ready to actively push. 
The study found that women in the peanut ball group had a significantly shorter first and second stage of labor. Additionally, the percentage of women who required cesarean surgery was significantly higher in the control group, with 21% of women in the control group requiring cesarean deliveries compared with 10% of women in the peanut ball group. The use of pharmacologic and instrumental intervention was not found to be statistically different between the 2 groups, and there were no negative outcomes associated with peanut ball use. 
The decrease in the length of both first and second stages of labor, along with the reduced cesarean surgery rates, support the efficacy of the peanut ball during active labor over current practices. Limitations of this study include the small study size and a significant difference between groups when it came to women's parity and cervical dilation. 
Osteopathic manipulative treatment (OMT) has been found to be effective for pregnancy-related pain and dysfunction when compared with standard intervention.3 Manual therapies have also shown promise as effective methods for pain relief during labor.4,5 However, there is a lack of studies examining OMT to improve labor progression.5 This study demonstrates the opportunity to improve labor length and outcomes by optimizing the shape of a laboring women's pelvis, which can also be targeted by several OMT techniques (eg, sacroiliac balanced ligamentous tension, muscle energy for somatic dysfunction in the pelvic region). Additional studies are needed to investigate the potential benefits of OMT in labor progress. 
References
Martin JA, Hamilton BE, Osterman MJ, Driscoll AK, Mathews TJ. Births: Final Data for 2015. Natl Vital Stat Rep. 2017:66(1):1-69. [PubMed]
Gifford DS, Morton SC. Fiske M, Keesey J, Keeler E, Kahn KL. Lack of progress in labor as a reason for cesarean. Obstet Gynecol. 2000:95(4):589-595. [PubMed]
Hall H, Cramer H, Sundberg R, et al The effectiveness of complementary manual therapies for pregnancy-related back and pelvic pain: a systemic review with meta-analysis. Medicine (Baltimore). 2016:95(38):e4723. [CrossRef] [PubMed]
Chaillet N, Belaid L, Crochetiere C, et al Nonpharmacologic approaches for pain management during labor compared with usual care: a meta-analysis. Birth. 2014:41(2):122-137. [CrossRef] [PubMed]
Ruffini N, D’ Alessandro G, Cardinali L, Frondaroli F, Cerritelli F. Osteopathic manipulative treatment in gynecology and obstetrics: a systematic review. Complement Ther Med. 2016:26:72-78. [CrossRef] [PubMed]