Tami Such

Date of Award

January 2020

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Dawn L. Denny

Second Advisor

Glenda Lindseth


Background/Purpose: Increased availability of intrapartum nitrous oxide in the United States given recent Food and Drug Administration (FDA) approval of associated delivery devices has provided women an alternative intrapartum pain management strategy currently underutilized in the United States despite long standing history of effectiveness in other countries (Richardson et al., 2017b). However, the effect of pain on the experience of birth and present emphasis on patient-centered care and shared decision-making, potential improvement of women’s satisfaction with the birth experience when nitrous oxide is used was an understudied concept in extant literature. Also, given the possibility of pain and comfort as coexisting forces whereby comfort is felt even in the presence of intense pain (Charles, Yount, & Morgan, 2016), study of the novel concept of comfort in response to intrapartum nitrous oxide use was warranted. Therefore, the purpose of this study was to determine if comfort and satisfaction with birth experiences differed for women who used nitrous oxide compared to epidural analgesics or no analgesics during the labor and birth process. The design of this between-subjects comparative study was guided by Kolcaba’s (2001) Theory of Comfort.

Methods: Based upon the following three self-selected intrapartum pain management methods, 84 pregnant women from three Midwestern healthcare facilities were consecutively enrolled into this study: 1) epidural analgesics (may have been in combination with other analgesic options, 2) nitrous oxide and oxygen (50-50% mixture) only, or 3) no analgesics. Study measures included: (a) the Birth Satisfaction Scale-Revised and (b) the researcher-modified version of the Childbirth Comfort Questionnaire.

Data were analyzed to determine comfort and satisfaction scores of the study participants. Differences among the comfort and satisfaction scores for the three groups of women were analyzed using ANOVA analyses.

Findings: Comfort experienced during labor and birth and satisfaction with the birth experience were similar for all study participants regardless of analgesic option used. No statistically significant differences in comfort (F(2, 81) = 1.11, p = .34) or in satisfaction with the birth experience (F(2, 81) = .084, p = .92) were found for women who used nitrous oxide, epidural analgesics, or no analgesics during labor and birth.

Conclusions and Implications for Clinical Practice: Findings from this study provide evidence regarding the absence of differences in comfort and satisfaction with the birth experience for women who used nitrous oxide compared to epidural analgesic or no analgesic use during the labor and birth process. Such findings are useful to inform clinical practice decisions of nurses and maternity care providers. Further, the findings support a shift in the paradigm of intrapartum pain management in the United States to include alternative pain management strategies, inclusive of routine nitrous oxide use.