Peanut ball may speed up labor for moms with epidurals

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria:Inclusion Criteria: To be eligible for participation, women must meet all the following criteria: * Primiparous (first pregnancy resulting in a live birth or stillbirth after 20 weeks of gestation). * Singleton at gestation. * Gestational age of the term (37 weeks 0 days to 41 weeks 6 days). * Admitted to the Labor and Delivery Unit at WWRC in active labor. * Received epidural analgesia for labor pain management. * Expected to have a vaginal delivery (e.g., no contraindications for vaginal birth identified at the time of recruitment). * Able to understand and communicate in Arabic or English. * Provide written informed consent. Exclusion Criteria:The birthing ball should NOT be used in any of the following conditions: 1. Obstetric Contraindications (Maternal) * Any situation where vaginal birth is not appropriate (e.g., absolute indication for cesarean section) * Non-progress of labor requiring immediate intervention * Severe pre-eclampsia/eclampsia * Active vaginal bleeding of unknown cause * Placenta previa (major) or vasa previa * Placental abruption (suspected or confirmed) * Preterm labor with medical contraindication to ambulation or mobility * Ruptured membranes with unstable fetal head (high station) → Risk of cord prolapse * Severe maternal exhaustion requiring bed rest * Maternal hemodynamic instability 2. Fetal Contraindications * Non-reassuring fetal heart rate requiring continuous monitoring (Category II-III tracings) * Malpresentation requiring immediate obstetric intervention (e.g., transverse lie) * Suspected macrosomia with mechanical obstruction concerns (e.g., cephalopelvic disproportion) * Multiple gestation with instability or complications 3. Orthopedic / Musculoskeletal Contraindications * Any condition that prevents safe sitting, balancing, or weight-bearing, such as: Severe hips, leg, knee, or pelvic injuries * Significant arthritis of the lower limbs or pelvis * Recent joint surgery (hip/knee replacement, pelvic repair) * Neuromuscular disorders affecting balance (e.g., severe neuropathy) * Severe sciatica limiting mobility * Poor trunk control or inability to maintain safe seated posture 4. High-Risk Pregnancy Conditions * Use of birthing balls is contraindicated if pregnancy is classified as high-risk, including Uncontrolled gestational diabetes and Uncontrolled hypertension * Intrauterine growth restriction with required continuous monitoring * Polyhydramnios or severe oligohydramnios (risk of cord compression/instability) * Preterm premature rupture of membranes (PPROM) * History of preterm birth with current instability * Any condition requiring bed rest or reduced mobility 5. Safety / Environmental Contraindications * Patients are unable to follow instructions or unsteady balance * No trained staff available to supervise during labor use Unstable or improperly sized birthing ball