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BackgroundIn many countries midwives act as the main providers of care for women throughout pregnancy, labour and birth. In our large public teaching hospital in Australia we restructured the way midwifery care is offered and introduced caseload midwifery for one third of women booked at the hospital. We then compared the costs and birth outcomes associated with caseload midwifery compared to the two existing models of care, standard hospital care and private obstetric care.MethodsWe undertook a cross sectional study examining the risk profile, birth outcomes and cost of care for women booked into one of the three available models of care in a tertiary teaching hospital in Australia between July 1st 2009 December 31st 2010. To control for differences in population or case mix we described the outcomes for a cohort of low risk first time mothers known as the 'standard primipara'.ResultsAmongst the 1,379 women defined as 'standard primipara' there were significant differences in birth outcome. These first time ‘low risk’ mothers who received caseload care were more likely to have a spontaneous onset of labour and an unassisted vaginal birth 58.5% in MGP compared to 48.2% for Standard hospital care and 30.8% with Private obstetric care (p < 0.001). They were also significantly less likely to have an elective caesarean section 1.6% with MGP versus 5.3% with Standard care and 17.2% with private obstetric care (p < 0.001). From the public hospital perspective, over one financial year the average cost of care for the standard primipara in MGP was $3903.78 per woman. This was $1375.45 less per woman than those receiving Private obstetric care and $1590.91 less than Standard hospital care per woman (p < 0.001). Similar differences in cost were found in favour of MGP for all women in the study who received caseload care.ConclusionsCost reduction appears to be achieved through reorganising the way care is delivered in the public hospital system with the introduction of Midwifery Group Practice or caseload care. The study also highlights the unexplained clinical variation that exists between the three models of care in Australia.

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Distinctive obsidian artefacts from West New Britain appear sometime before 3950 cal BC and terminate abruptly at 1650 cal BC. We propose that they had a wide range of meanings for their users and functioned in both utilitarian and ceremonial contexts, similar to more recent ground stone axes from Highland New Guinea. They therefore represent the earliest evidence for valuables in Papua New Guinea. Here we draw together studies of the technology, spatial distribution, and chemical sourcing of the artefacts, along with considerations of fragility and brightness, to evaluate competing models for their function as utilitarian items and as exchange goods. Whereas many artefacts were probably useful tools integrated within a mobile settlement pattern, others were clearly reserved for special functions, and many may have operated in both the utilitarian and ceremonial spheres.

The presence of an archaeological site on Kosipe Sacre Coeur Mission was first noted in 1960, when axes and waisted blades were found by Father L. Willem during excavations for church foundations. Word of the site was sent to Mr W. Tomasetti, then Assistant District Officer, Department of Native Affairs, Tapini, and he informed White of it. Excavations were made there in June 1964 (White, 1965, 41–3; 1967). In 1966 the site was visited by Crook who collected further carbon and soil samples and in August 1967 White and Ruxton carried out further archaeological and geomorphological investigations. This report covers the entire history of excavations at the site.Kosipe lies about 135 kilometres north of Port Moresby and 20 kilometres north northwest of the Woitape Sub-District office, Central District, Papua, at 147° 16′ E, 8° 21′ S (fig. 1). The area around Kosipe has not yet been the object of a reconnaissance geological survey. Observations by Crook along the Woitape-Kosipe road, south of Kosipe and on the Kosipe-Tanipai track northwest of Kosipe along the Ivane River indicate that the oldest rocks are slates and other low grade metamorphics of unknown age with steeply dipping foliation. These are overlain, probably sub-horizontally, by several hundred feet of basic volcanics, probably largely basalt. The volcanics are probably of late Tertiary or early Quaternary age; they are strongly dissected and are not obviously related to any centres of extrusion.