Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For low-risk women delivering a full-term baby vaginally, what is the comparative effectiveness of the use of nitrous oxide for pain management versus an epidural or other pain management strategies. What are the effects on the birth experience and maternal and child health outcomes? Is there evidence to suggest the use of nitrous oxide could decrease rates of cesarean sections in the US?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Nitrous oxide, epidural, other pain management strategies for labor and delivery.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Low-risk, pregnant women delivering full-term babies.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Effective pain management during labor & delivery

Describe any health-related risks, side effects, or harms that you are concerned about.

Health effects to newborn Dizziness, loss of consciousness

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Pregnancy, including preterm birth

AHRQ Priority Populations

• Women
• Children

Federal Health Care Program

None

Importance

Describe why this topic is important.

Effective pain management strategies during labor and delivery can have significant impacts on the birthing experience as well and maternal and child health outcomes.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Most maternity units in the US do not promote/make available the use of nitrous oxide. There is currently controversy in the US over the effectiveness and safety of nitrous oxide in delivery.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Describe the timeframe in which an answer to your question is needed.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program