Hawaiʻi Home Birth Collective, LLC (HiHBC) uses three types of peer review:

  • Community Peer Review/Hoʻoponopono is routine, confidential, professional, non-punitive, and educational.

  • Complaint Review addresses a complaint against a midwife and may result in educational or peer supervision recommendations.

  • Grievance Mechanism addresses the second and subsequent complaints against a midwife. A midwife who has been named in a written complaint to HiHBC is required to participate in the HiHBC Complaint Review and/or Grievance Mechanism. Failure or refusal to participate in the accountability process will result in removal from the HiHBC organization.

    **To file a complaint/grievance complete the following form and submit. Please read the complaint/grievance process described below.

Community Peer Review/Hoʻoponopono

All practicing midwives and their apprentices/students are encouraged to attend local, routine Community Peer Review at least twice per year. In emergent or urgent cases, only invited midwives should be in attendance.

At least one elder council midwife will be in attendance for every peer review to act as a mentor and to offer the experience and advice that only an elder with at least 15 years of experience can provide.

Community Peer Review/Hoʻoponopono brings practicing midwives in Hawaiʻi together on a regular basis to discuss their cases and learn from each other. It is an opportunity for cohesiveness within our community and can serve as a foundation when difficult situations arise.

Beyond community support lies the professional ethical concerns. Confidential peer review/Hoʻoponopono adds validity to the midwifery process and is required in many other settings.

Consumers can know that their practitioner participates in peer review, and that, if a concern is raised, there is a platform for discussion and follow-up.

Other health care practitioners can also know and recognize the professionalism involved in maintaining Community Peer Review/Hoʻoponopono.

If a formal complaint is filed against a midwife, the first place the complaint will be addressed officially will be in local Peer Review/Hoʻoponopono and will utilize the Complaint Review process or similar format that must include the participation of the client.

Community Peer Review/Hoʻoponopono Process

Prior to the start of peer review, each midwife notifies the facilitator the number of cases they have to review and how much time they estimate they will need to present them.

At the opening of the meeting, the facilitating Elder committee member reviews the basic guidelines for Community Peer Review as listed below. 

The information presented at Community Peer Review is confidential.

The intention of community peer review is not punitive or critical but supportive, educational, and community based. Positive feedback is encouraged, concerns should be raised respectfully and with the assumption that feedback is welcome.

While a midwife presents a case, everyone remains quiet. Questions are asked after the midwife has finished or opens up her presentation for comments/questions.

Recommendations and support are made by the group . 

The midwife must present all cases involving consultation, transfer of care, transport to the hospital, instances where the midwife is outside of practice guidelines (including in these, the process of Informed Choice that was used), and cases where the midwife requests more input from the community of midwives. It is helpful to the community if the midwife also discusses interesting cases or situations. (In the case of a significant negative outcome, an emergency peer review must be called within 1 week of the event by contacting an Elder midwife committee member who will call for the peer review.)

When presenting a case, the following information should be available:

Gravidity and parity of client along with any significant medical or OB history or psychosocial concerns;

Relevant lab work and test results, if any;

Significant information regarding pregnancy, birth and postpartum;

Consultations with other providers (cultural and traditional midwives, MDs, DCs, NDs, DOs, CNMs, etc.); and include the present care plan and how that may change with the ongoing situation. 

After everyone presents their cases and discussion has ended, the Community Peer Review group is encouraged to discuss professional educational objectives for the current year.

If a conflict arises between a client and a midwife, a local Community Peer Review may discuss the details with the midwife. HIHBC urges the use of our HIHBC Complaint Review process, which includes participation of the client whose course of care initiated the complaint.

Complaint/Grievance Review

HiHBC recognizes that each registered midwife will practice according to their own conscience, practice guidelines, and skill levels.

When a midwife acts beyond her guidelines for practice, the midwife must be prepared to give evidence of informed choice. The midwife must be able to show that the client was fully informed of the potential negative consequences, as well as the benefits of proceeding outside of practice guidelines.

HiHBC recognizes its responsibility to Hawaiʻi midwives and the community to protect the integrity and the value of this process. This is accomplished through the availability of the Complaint Review and Grievance Mechanism processes.

  • A Complaint Review addresses a complaint against a midwife. This initiates a formal process that must include the participation of the midwife and the client.

  • When a written complaint against a midwife is received by HiHBC, it is referred to the HiHBC elder’s council.

  • A second complaint against a midwife or midwife apprentice/student may not involve the same incident. However, a second complaint is addressed by a Grievance Committee which consists of HiHBC elders and Founding Directors and initiate the Grievance Mechanism.

    1. The Complaint Review/Grievance Committee will review, the written complaint letter, and the midwife’s chart, practice guidelines, and midwife’s statement.

    2. The midwife and the complainant are notified to schedule a Complaint Review session.

    3. All parties agree to uphold confidentiality.

    4. The agenda for the session is read.

    5. The complaint is read aloud by an Elder committee member.

    6. The complainant gives an accounting of the complaint, and any additional testimony on the complainant’s behalf is given or read.

    7. The committee may ask questions of the complainant and supporting testifiers.

    8. The complainant and supporting testifiers are excused.

    9. The midwife presents the case. Supporting testimony is given or read.

    10. The committee may ask questions of the midwife and supporting testifiers.

    11. The midwife is excused from proceedings.

    12. The Complaint Review/Grievance Committee discuss the case. Recommendations and findings are made.

    13. The final outcome of the proceedings is given in writing to the midwife and complainant and the case is closed.

    14. Ho’oponopono is initiated with a cultural practitioner when requested.

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