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.