The effect of exercise with special ball during pregnancy on duration of active phase of first stage of birth in nulliparous women

Document Type : Original Article


1 Instructor of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.

2 MSc student of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran..

3 Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Associate professor, Department of Obstetrics and Gynecology, Women,s Health Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Associate professor, Department of Sport Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

6 Professor, Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: Prolonged labor is associated with numerous problems for mother and baby. Exercise with labor ball is one of non-pharmacological and effective methods in delivery. Since the study which evaluated the effect of exercise with birth ball during pregnancy was not found in valid databases, thus, this study was performed with aim to determine the effect of exercise with special ball during pregnancy on duration of active phase of first stage of labor in nulliparous women.
Methods: This randomized clinical trial was performed on 50 nulliparous women with gestational of 34 weeks referred to obstetric clinic of MashhadOmolbanin hospital from Aug 2013 to Feb 2014. They were randomized in two group of control (n=25) and intervention (n=25). The mothers in intervention group performed exercise regularly with birth ball for 6-4 weeks from 34 weeks of gestation for 16-24 session,and the control group received routine care. Then, length of first stage of labor in both group was measured with onset of active phase of labor in the maternity. Data were collected by Questionnaire forms, exercise record check list, observation and examinationof first stage of labor. Data were analyzed using SPSS software (version 16), and Mann-Whitney test, independent t-test, paired t-test and chi-square test. PResults: The mean duration of active phase of first stage of labor was 409.52 ± 6.6 minutes in intervention group and 430.20 ± 0.37 minutes in control group that two groups were significantly different in terms of duration of active phase of first stage of labor (P=0.007).
Conclusions:Exercise program with birth ball during pregnancy can help the patients as a useful and low cost method for reducing the duration of active phase of labor, and also decreases the complications of prolonged labor in mother and baby and consequently reduces the instrumental and cesarean delivery.

  1. Engebreston JC, Littlon LY. Maternal and neonatal and womens nursing. 1th ed. Delmar, USA: Delmar Publishing; 2002. P. 517-47, 866.
  2. Rahimikian F, Modaress M. Graphical analysis of delivery progression. J Tehran Univ Med Sci 2002; 11(24):97-106. (Persian).
  3. Nystedt A, Hogberg U, Lundman B. The negative birth experience of prolonged labour: a case-referent study. J Clin Nurs 2005; 14(5):579-86.
  4. Fraser WD, Cayer M, Soeder BM, Turcot L, Marcoux S. Risk factors for difficult delivery in nulliparas with epidural analgesia in second stage of labor. Obstet Gynecol 2002; 99(3):409-18.
  5. Abasi Z, Abedian Z, Fadaii A. Effect of massage on the duration of first stage of labor. Arak Med Univ J 2008; 11(1):63-71. (Persian).
  6. Stokowski LA. Make every mother and child count--World Health Day. Adv Neonatal Care 2005; 5(3):124.
  7. Drif JO, MaGowan B. Clinical obstetric and gynecology. Edinburgh: Saunders; 2004.
  8. Kolas T, Hofoss D, Daltveit AK, Nilsen ST, Henriksen T, Hager R, et al. Indications for cesarean deliveries in Norway. Am J Obstet Gynecol 2003; 188(4):864-70.
  9. Nazari F. Comparison of conventional and selective maternal position on the labor pain and duration of the active phase of labor. [Master Thesis]. Mashhad, Iran: School of Nursing and Midwifery of Mashhad; 2002. (Persian).
  10. Row-Murray HJ, Fisher JR. Operative intervention in delivery is associated with compromised early mother-infant interaction. BJOG 2001; 108(10):1068-75.
  11. Kaptchuk TJ. Acupunture: theory, efficacy and practice. Ann Intern Med 2002; 136(3):374-83.
  12. 12-Gottvall K, Waldenstrom U. Does a traumatic birth experience have an impact on future reproduction? BJOG 2002; 109(3):254-60.
  13. Zeitlin D, Keller SE, Shiflett SC, Schleifer SJ, Bartlett JA. Immunlogical effect of massage therapy during academic stress. Psychosom Med 2005; 62(1):83-4.
  14. Weiss RE. Birth ball for pregnancy, labor and birth making labor more comfortable. About Health. Available at: URL:; 2014.
  15. Watkins SS. Get on the ball-the birth ball that is! Int J Childbirth Educ 2001; 16(4):17-9.
  16. Perez P. Birth balls:use of a physical therapy balls in maternity care. Vermont: Cutting Edge Press; 2000.
  17. Carriere B, Tanzberger R. The swiss ball: theory, basic exercises and clinical application. Sao Paulo: Springer Science & Business Media; 1999.
  18. Kwan WS, Chan SW, Li WH. The birth ball experience: outcome evaluation of the intrapartum use of birth ball. Hong Kong J Gynaecol Obstet Midwifery 2011; 11:59-64.
  19. Delgado-Garcia BE, Orts-Cortes MI, Poveda-Bernabeu A, Caballero-Perez P. Randomised controlled clinical trial to determine the effects of the use of birth balls during labour. Enferm Clin 2012; 22(1):35-40.
  20. Mathew A, Nayak S,Vandana KA, Hegde ND, Kumari S, Hegde MN, et al. Comparative study on effect of ambulation and biriting ball on maternal and newborn outcome among primigravida mothers in selecte hospitals in Mangalor. Nitte Univ J Health Sci 2012; 2(2):49-71.
  21. Taavoni S, Abdolahian S, Haghani H. Effect of birth ball on pain severity during the active phase of physiologic labor. Arak Med Univ J 2010; 13(1):25-31. (Persian).
  22. Gau ML, Chang CY, Tian SH, Lin KC. Effects of birth ball exercise on pain and self-efficacy during childbirth: a randomised controlled trial in Taiwan. Midwifery 2011; 27(6):e293-300.
  23. 23.     Park JE. Textbook of prevelantive and social medicine. 4th ed. New York: McGrawHill; 1998.
  24. Guillbaurd J. Contraception and sexual health. Best Pract Res Clin Obstet Gynecol 2009; 23(2):163-4.
  25. Backman G, Hunt P, Khosla R, Jaramillo-Strouss C, Fikre BM, Rumble C, et al. Health system and the right to health: an assessment of 194 countries. Lancet 2008; 372(9655):2047-85.
  26. Silva LM, Oliveira FM, Silva FM, Alvarenga MB. Using the Swiss ball in labor. Acta Paulista Enfermagem 2011; 24(5):656-62.
  27. Walmsley K. Caring for women progress in labour. Br J Midwifery 2003; 8(7):449-57.
  28. Boland Hemmat M, Saadati Z, Jajondyan R. Effect of exercise on the incidence of oxypot posterior in nulliparous women at late pregnancy. Babol Univ Med Scie J 2006; 8(7):30-6. (Persian).
  29. Khaldan A, Mirdar SH, Motahari Tabari NS, Ahmad Shirvani M. Effect of an aerobic exercise on fetal growth in pregnant women. J Hayat 2010; 16(1):55-64. (Persian).
  30. Price BB, Amini SB, Kappeler K. Exercise in pregnancy: effect on fitness and obstetric outcomes-a randomized trial. Med Sci Sports Exerc 2012; 44(12):2263-9.
  31. Gray CF, Gant NF, Leveno KJ, Gilstrap LC, Hauth JC, Wenstrom KD. Williams obstetrics. 23th ed. New York: Mc Graw-Hill; 2010. P. 638-50.
  32. Faraser DM, Cooper MA. Myles textbook for midwives. 15th ed. Edinburgh: Churchill Livingston; 2010.
  33. Eslamian L, Marsoosi V, Pakneeyat Y. Increased intravenous fluid intake and the course of labor in nulliparous women. Int J Gynaecol Obstet 2006; 93(2):102-5.