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Determinants of satisfaction among women who deliver vaginally using nitrous oxide as their sole labor analgesic: A conventional qualitative content analysis of recorded patient comments
Abstract Number: F-49
Abstract Type: Original Research
Aim: One in five laboring women at our center use nitrous oxide (N2O), and of those who go on to deliver vaginally, 60% use N2O as their sole analgesic. Most (93%) who use N2O report high satisfaction despite variable analgesic effectiveness (nearly half report low/intermediate effectiveness). We analyzed postpartum survey comments of women who delivered vaginally using N2O as thier only analgesic. We aimed to identify factors contributing to satisfaction, and to better understand motivations to continue using N2O despite ineffective analgesia.
Methods: We performed conventional qualitative content analysis of textual responses from a previously reported database. Two investigators reviewed and coded responses independently, and developed a provisional coding manual using an inductive grounded approach. Analyses were compared, disagreements were resolved through consensus, and revised manuals were used to independently code a larger subset of responses. This was repeated for the entire data set. Emergent themes were identified collaboratively, and are presented with the number of coded textual references in each theme.
Results: Of 6507 vaginal deliveries over 34 months in 2011-2014, 1246 women used N2O, including 753 using N2O as their sole analgesic. 678 of these had postpartum surveys, and 264 included clarifying comments for analysis. Of these, 33 failed to clarify positive experiences with N2O, and 41 failed to explain high satisfaction despite low analgesic effectiveness. Analysis of the remaining 190 comments revealed 11 emergent themes (Table). Parturients cited numerous beneficial non-analgesic attributes of N2O use, as well as partial analgesic effects that they deemed to be sufficient, or in keeping with their expectations. Numerous women described their N2O experience as consistent with their birth plan, including 14 who equated it with natural childbirth. Some described using N2O when neuraxial analgesia was not possible. Side effects were cited, as were difficulties using the apparatus/mask. Analysis revealed the importance of timely administration on request and attention to technical aspects, as well as a potential role for N2O analgesia for post-delivery procedures.
Discussion: Our results demonstrate that among parturients who choose N2O as their sole labor analgesic, determinants of patient satisfaction are more variable than previously understood.
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2. Hsieh. Qual Health Res 2005;15:1277