Somewhere in labor, a nurse may bring in an inflatable ball shaped like a peanut shell and tuck it between your knees.
A peanut ball for labor is a ball you place between your legs while you lie on your side, and NHS hospital guides say you can use one with an epidural. Below: how it differs from a birthing ball, the positions NHS hospital guides describe, what ACOG and WHO say about moving with an epidural, and how to ask for one so you can put it in your birth plan.
A peanut ball is a birthing ball you place between your legs while you lie on your side, and two NHS hospital guides say you can use one with an epidural. ACOG supports frequent position changes in labor and WHO backs a birth position of your choice, epidural or not, but none of the ACOG, WHO or NHS pages we read cites a peanut-ball trial, so ask whether your unit has one and what they've seen.
Key Takeaways
- It goes between your legs while you lie on your side (Rotherham NHS).
- You can use one with an epidural, say two NHS hospital guides, though ACOG notes you may not be able to walk.
- Moving still matters with an epidural. WHO recommends a birth position of your choice, with or without one.
- Availability varies. One NHS hospital keeps them on site; another asks you to bring your own.
What Is a Peanut Ball for Labor?
The Rotherham NHS Foundation Trust calls peanut balls "a type of birthing ball" and describes using one between your legs while you lie on your side. For plain side-lying without the ball, Rotherham suggests a pillow, rolled-up blanket or stirrup to support your upper leg.
Because you use it lying down, the trust says, it suits you if you have an epidural or would rather labor on the bed than stay upright.
ACOG's labor guidance, WHO's 2018 recommendations and the NHS website's labor pages don't mention the peanut ball, so the practical detail here comes from the guides of six NHS hospital trusts.
Peanut Ball vs Birthing Ball
| Round birthing ball | Peanut ball | |
|---|---|---|
| Shape | Round, rolls every way | Rolls one way only |
| Main use in labor | Sitting and rocking on it, or leaning over it | Between your legs while lying on your side; help getting into a squat |
| With an epidural | Not covered in our sources | Rotherham and North Tees and Hartlepool say you can |
| Size | 65cm (26in) up to 5ft 8in, 75cm (30in) if taller | A little smaller; no size chart found |
Sources: Mersey and West Lancashire NHS, plus Rotherham and North Tees and Hartlepool for the epidural row.
The Mersey and West Lancashire leaflet suggests a peanut-shaped ball if you feel unsteady sitting on a round one. Its sitting advice is for round birthing balls: feet flat on the floor about 24in (60cm) apart, with someone steadying the ball from behind the first few times. It also warns that the floor gets slippery once your waters break, so stay off any ball until your midwife has made the area safe.
Peanut Ball Labor Positions
ACOG finds "little evidence that any one position is best," and says a position has to leave room for the monitoring and care you need. Your nurse or midwife can help you set up each of these.
Side-Lying With the Ball Between Your Legs
Lie on your side with your knees bent, as Rotherham describes, with the ball between your legs. Our suggestion: have your partner hold the ball steady while you settle.
- With an epidural? Yes, say Rotherham and North Tees and Hartlepool. The NHS notes an epidural can make your legs feel heavy. Our practical tip: ask your nurse to help you get the ball into place.
Knees In, Soles Out
Royal Berkshire's biomechanics for birth leaflet lists "knees in, soles out," with a peanut ball as an option, for when your midwife finds your baby low in your pelvis. The leaflet names the position without picturing it, so ask your midwife to show you.
- With an epidural? The leaflet doesn't say, so ask.
Squatting With the Ball
The Mersey and West Lancashire leaflet says peanut-shaped balls can help you get into squatting positions for labor. Rotherham adds that squatting is often best done with a birth partner's support.
- With an epidural? Our sources don't cover it. Squatting relies on your legs, and ACOG says you may not be able to walk with an epidural, so check with your nurse.
Labor Positions With an Epidural
ACOG's pain relief FAQ says you can move with an epidural but may not be able to walk. The NHS says how much you can move your legs depends on the local anesthetic used, and your legs may feel heavy.
Monitoring shapes your options too. The NHS says an epidural means continuous monitoring of your contractions and your baby's heart rate, with a belt around your abdomen and possibly a clip on your baby's head. Some hospitals offer "mobile" epidurals that let you walk around, but the NHS says they need wireless monitoring that many hospitals don't have.
Why Changing Position Still Matters
ACOG's Committee Opinion 766, reaffirmed in 2025, says frequent position changes for your comfort and your baby's position can be supported, as long as the position allows the monitoring and care you need. It notes that lying flat on your back has known downsides, such as low blood pressure (supine hypotension) and more frequent dips in your baby's heart rate.
The WHO recommends encouraging a birth position of your choice, upright positions included, with or without an epidural. For pushing, ACOG cites a 2017 trial in first-time mothers with low-dose epidurals: those assigned to upright positions had fewer spontaneous vaginal births than those assigned to lying down (adjusted risk ratio 0.86).
None of our sources gives a schedule for changing position with the peanut ball, so follow your nurse's lead. For sitting propped up in bed (Bloom's "Semi-reclined"), our sources describe no peanut ball setup, so ask your nurse.
For the epidural decision itself, our guide to epidural pros and cons covers the trade-offs, and our guide to other labor positions covers the options off the bed.
Side-Lying Release, a Separate Technique
Royal Berkshire's leaflet also describes side-lying release, a technique without a ball that it lists for babies lying back-to-back, and says it can be done with an epidural if someone steadies your hips and supports your leg. It needs your consent, should never cause pain, and isn't for anyone with significant pelvic pain or a past back or spinal injury; our back labor guide covers the pain a back-to-back baby can bring.
Put the peanut ball in your plan. In Bloom, our birth plan builder, mark "Epidural" under Pain relief options and "Side-lying" under Birth positions, then add "Please offer a peanut ball" under Special wishes. Download the PDF, or send it to your care team by email.
Does a Peanut Ball Help Labor?
Our sources recommend changing position in labor, including with an epidural. None of the ACOG, WHO or NHS pages we read cites a peanut-ball trial, so ask your care team what they've seen.
Some NHS hospital pages sound more hopeful about the ball, but none points to the research behind those statements, so we've left them out.
ACOG does report research on position in general. In a meta-analysis it cites, upright positions in the first stage of labor shortened that stage by about 1 hour and 22 minutes compared with lying down on your back or side, and the people who were upright were less likely to have a cesarean (risk ratio 0.71). ACOG adds that the effect of position is hard to isolate.
Can a Peanut Ball Open Your Cervix?
No source we used says so. Two NHS trust pages say side-lying, or the ball, helps open your pelvis. Those pages say pelvis, not cervix, and none cites a study.
The NHS says your cervix needs to open to about 10cm. If labor is slower than expected, your midwife or doctor may talk to you about breaking your waters or an oxytocin drip.
What Size Peanut Ball for Labor?
We found no peanut ball size chart from ACOG, WHO or the NHS. The Mersey and West Lancashire leaflet says peanut-shaped balls tend to be a little smaller than round birthing balls.
It sizes round balls for sitting: 65cm (26in) if you're up to 5ft 8in, 75cm (30in) if you're taller, with your knees about 4in (10cm) below your hips. A ball between your knees does a different job, so ask the nurse or midwife setting it up, or ask on your hospital tour before you buy one.
How to Ask for a Peanut Ball
Hospitals differ. Newcastle Hospitals says peanut balls are available in the hospital and asks you to tell your midwife if you'd like to try one. University Hospitals Bristol and Weston's birth options leaflet says you need to bring your own to its Central Delivery Suite.
Questions for your hospital tour or a prenatal visit:
- Do you have peanut balls, or should I bring my own?
- Can I use one with an epidural, and who will help me onto it?
- Which positions fit the monitoring I'll need?
- Is a mobile epidural available here?
A review of women's experiences of labor companionship, summarized in WHO's 2018 guidance, found that companions help women into different positions, such as sitting on a ball. Decide who'll be in the room to help, and show them the setup before your due date.
One line under Special wishes covers the request: "If I have an epidural, please offer a peanut ball and help me change sides."
Frequently Asked Questions
What is a peanut ball used for in labor?
It's a peanut-shaped birthing ball you place between your legs while you lie on your side. The Rotherham NHS trust calls it a good option if you have an epidural or would rather labor lying on the bed.
Can you use a peanut ball with an epidural?
Two NHS hospital guides, from Rotherham and North Tees and Hartlepool, say you can. ACOG says you can move with an epidural but may not be able to walk. Practical tip: ask your nurse to help you get the ball into place.
What are the best peanut ball positions?
No source ranks them, and ACOG finds little evidence that any one labor position is best. NHS guides describe side-lying with the ball between your legs, knees in and soles out with a peanut ball, and using one to help you squat.
What is the difference between a peanut ball and a birthing ball?
A round birthing ball rolls in every direction and is mostly sat on or leaned over. An NHS leaflet says a peanut ball only rolls one way and tends to be a little smaller, and Rotherham NHS describes it between your legs while you lie on your side.
What size peanut ball do I need for labor?
ACOG, WHO and the NHS give no peanut ball size chart. One NHS leaflet sizes round birthing balls by height (65cm up to 5ft 8in, 75cm if taller) and says peanut balls tend to be smaller. Ask the nurse or midwife setting it up.
Can a peanut ball help open your cervix?
No source used here says it does. ACOG supports changing position in labor and WHO recommends staying mobile, but neither mentions the ball. If labor is slow, your midwife or doctor can explain options such as breaking your waters or an oxytocin drip.
Before Your Hospital Tour
Take the four questions above to your next prenatal visit, then add what you learn to your birth plan so the nurse on shift sees it in writing.
This article is for information only and does not replace medical advice from your OB or midwife.
How This Guide Was Made
The Babysential Team wrote this guide from the ACOG, WHO and NHS documents below, checked on October 9, 2026, with AI-assisted drafting. The practical peanut ball detail comes from NHS hospital guides, and our own suggestions are marked as such.
Sources
- Approaches to Limit Intervention During Labor and Birth, Committee Opinion No. 766. ACOG, 2019, reaffirmed 2025
- Medications for Pain Relief During Labor and Delivery. ACOG, 2024
- WHO recommendations: intrapartum care for a positive childbirth experience. WHO, 2018
- Pain relief in labour. NHS, 2023
- The stages of labour and birth. NHS, 2023
- Labour and birthing positions. The Rotherham NHS Foundation Trust, 2026
- Biomechanics for birth. Royal Berkshire NHS Foundation Trust, 2024
- Positions for labour. Newcastle Hospitals NHS Foundation Trust, 2025
- Coping during labour. North Tees and Hartlepool NHS Foundation Trust, 2026
- Using a Birthing Ball during Pregnancy and for Labour. Mersey and West Lancashire Teaching Hospitals NHS Trust, 2023
- Birthing Options at University Hospitals Bristol and Weston. UHBW NHS Foundation Trust, 2023
