Purpose <p>To evaluate the effect of peanut ball usage on labor pain birth comfort, and length of childbirth among pregnant women during childbirth.</p> Methods <p>This randomized controlled trial included both primiparous groups, each of which was divided into intervention and control groups. 102 pregnant women were enrolled and randomized into the peanut ball group (PG: 51) and control groups (CG: 51). Experimental-group women used peanut balls during labor of active and transition phase. After the cervical dilatation reached 4 cm, the pregnant women in the PG performed peanut ball exercises, adhering to the peanut ball guide created by the researcher. Control-group women standard midwifery care for the same period as the experimental group. The Visual Analog Scale (VAS), the Birth Comfort Scale (BCS), and the Partograph were used to measure outcomes. </p> Results <p>The process of dilation, effacement, and descent of the fetal head showed statistically significant differences between both groups after intervention (p&lt;0.05). However, the length of childbirth was similar between both groups. The birth pain scores of the pregnant women in the PG were significantly lower and increased physical and psychospiritual comfort at birth (p&lt;0.05).</p> Conclusion <p>It was determined that the use of peanut ball by pregnant women during labor does not affect the length of childbirth, reduce labor pain, and increase physical and psychospiritual comfort.</p> Trial registration <p>The study was retrospectively registered in National Library of Medicine Clinical Trials Registry (Date: 12.16.2023 Ref: NCT06200688).</p>