QUESTION: What is the effect of a protocol targeted at the various stages of labour - with a peanut ball, positioning and pelvic mobility - on the duration of labour, pain severity, fatigue, maternal outcomes, neonatal outcomes and satisfaction in parturients without analgesia? DESIGN: A randomised trial with concealed allocation, blinding of assessors and intention-to-treat analysis. PARTICIPANTS: One hundred women in active labour. INTERVENTION: The experimental group received the protocol targeted at the various stages of labour, with a peanut ball, positioning and pelvic mobility, whilst the control group received usual care. OUTCOME MEASURES: The primary outcomes were the duration of labour and pain severity. The secondary outcomes were maternal fatigue, mode of delivery, risk of perineal laceration, severity of perineal laceration, use of synthetic oxytocin, satisfaction with delivery, Apgar scores, admission of the neonate to an intensive care unit and resuscitation of the neonate in the delivery room. In the active phase of labour, the numerical rating scale and maternal perception of childbirth fatigue questionnaire were applied; they were taken again when the parturient had 8 to 10 cm of dilation. The numerical rating scale was also applied postpartum to evaluate satisfaction with childbirth. RESULTS: The use of the protocol with a peanut ball reduced the duration of active and expulsive phases and the total duration of labour, with mean differences of 82 minutes (95% CI 41 to 125), 8 minutes (95% CI 0 to 18) and 89 minutes (95% CI 45 to 132), respectively. Maternal satisfaction was better in the experimental group: mean between-group difference on the 10-point scale was 1.1 (95% CI 0.4 to 1.8). The effects on the other outcomes were either similar between groups or unclear. CONCLUSION: A protocol with a peanut ball, positioning and pelvic mobility reduced the duration of labour and improved maternal satisfaction with childbirth. REGISTRATION: RBR-74wcnjc.

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