Usefulness of a nondashexperimental study design in the evaluation of service developments for infant feeding in a general hospital

There are likely to be many situations in which it is not possible to use a randomized controlled trial (RCT) for the evaluation of local service developments, and the usefulness of nondashexperimental study designs need to be assessed. This is examined with reference to a study carried out to evaluate the appointment of a baby feeding adviser (BFA) and other policy changes for infant feeding at a district general hospital (DGH). Surveys of Maternity Unit staff attitudes and practices, and of mothers' experiences were carried out in 1988 (prior to the changes) and afterwards in 1990. Service changes were; appointment of a BFA, removal from the postnatal wards of dextrose, seminars on baby feeding for midwifery staff, and a reduction of night-only shifts. There was no change in the initial breast feeding rate of about 80%, but there was an increase in breast feeding at 6 weeks postnatally from 57% (95% CI; 51-64) to 64% (95% CI; 59-69); P = 0.15. The percentage of women who stopped breast feeding by 6 weeks fell from 30% in 1988 to 22% in 1990; P = 0.11. Mothers who did not see the BFA (1990 only) were significantly less likely to begin breast feeding (P = 0.03), independent of social class and age, but a similar association was not seen at 6 weeks. There were significant reductions in the percentage of midwifery staff viewing feeding policy as unimportant (P = 0.02), and in the use of supplements for breast-fed babies (P