​Although its analgesic effectiveness varied, the use of nitrous oxide during labor resulted in high patient satisfaction scores, suggesting that satisfaction with labor analgesia is not determined solely by the level of pain relief achieved, according to a study published in the February 2017 issue of Anesthesia & Analgesia. The authors surveyed on the first postpartum day women who delivered vaginally and received anesthetic care during labor and delivery. Survey respondents were asked to rate their satisfaction on a scale of 1 to 10, with the authors grouping the scores into high (8 to 10), intermediate (5 to 7), and low (0 to 4) categories. Of 6,242 women surveyed for whom data were available, 81% (5,261) chose neuraxial analgesia (defined as epidural or combined spinal-epidural) and 19% (1,246) elected to receive nitrous oxide; of the latter group, 753 delivered with nitrous oxide alone, and the remaining 493 switched to neuraxial analgesia at some point during labor. Although nearly half (48%) of the women who received nitrous oxide alone experienced variable levels of analgesic effectiveness, overall satisfaction scores among the three groups of women were universally high: 93% of women who delivered with nitrous oxide alone rated their overall satisfaction as high, compared with 96% and 97%, respectively, of women who started with nitrous oxide and continued to neuraxial analgesia or elected to receive only neuraxial analgesia. In addition, among participants who reported poor analgesic effectiveness, those who received only nitrous oxide "were more likely to report high overall satisfaction than those who received neuraxial analgesia alone," according to the authors. The authors concluded that, although pain relief contributes to satisfaction with labor, other factors—such as preservation of bodily sensations of labor, mobility, strength, caregiver support, and patient involvement in decision making—may also play a role in overall patient satisfaction and contribute to a more desirable birth experience. In an accompanying editorial, William Camann, MD, emphasizes that, although there is a common perception that pain is always undesirable, "a large body of research indicates that satisfaction during labor is not necessarily directly correlated with pain or pain relief." The editorial suggests that "prelabor expectations, caregiver attitudes during labor, emotional support during labor, and other, often difficult-to-quantify factors, are also critical in determining the degree of satisfaction from the childbirth experience."

HRC Recommends: Patient satisfaction is at the crux of many of the fundamental goals a risk manager works toward every day. Risk managers will want to review this study and send it to the various departments listed below for review to determine the implications for policies and procedures at the facility.