Hawai`i Home Birth Collective, LLC

legislative Update 2024

Now is the time to work with your Representative and Senator to legalize birth attendants, because Act 32 (2019) said the legislature was going to come back and legalize them, but has yet to do so.

NOW IS THE TIME TO work WITH and educate YOUR REPRESENTATIVE AND SENATOR as to why it is crucial TO LEGALIZE BIRTH ATTENDANTS

INTRODUCED IN 2023, HB 955 PASSED THROUGH BOTH THE HEALTH AND CONSUMER PROTECTION COMMITTEES BEFORE GETTING “HELD UP” IN THE FINANCE COMMITTEE. SINCE THEN IT HAS REMAINED “DORMANT”. HB2649/SB2969 AND HB407 WERE INTRODUCED TO THE LEGISLATURE TO FIX MANY OF THE ISSUES THAT HRS-457J - HAWAI’I’S MIDWIFERY LICENSURE LAW - HAS CREATED SINCE IT’S INCEPTION IN 2019. THE LEGISLATION INTRODUCED FOR THE 2024 SEASON FAILED TO GAIN MUCH TRACTION AND ALL THREE DIED BEFORE THEY HAD A CHANCE TO GET STARTED… in early march 2024, HB 955 REMAINed AN ACTIVE AND VIABLE BILL AND HAd THE ABILITY TO PICK UP RIGHT WHERE IT LEFT OFF IN THE HOUSE FINANCE COMMITTEE or bypass it all together and move to the senate.

Representative Diamond Garcia brought HB955 to the House of representatives floor session on March 7, 2024 in an attempt to move it past the finance committee and over to the senate. you can watch who stood with the bill, who was intentionally absent from the proceedings, and who stood against the possibility of reconciliation that day in the video link below. this was the state of Hawaii’s last opportunity to correct HRS-457J before facing the lawsuit filed on February 27, 2024 and the legislation failed to attempt to make any change.

The Bills for the 2024 Legislative Session below are no longer viable, but HB 955 from 2023 is!

SB2969 HB2649

These companion bills acknowledge many important factors when it comes to Access to Reproductive Care across the Hawaiian Islands.

These bills address the language in Act 32 which defines “midwifery” with such a wide scope, that doulas, childbirth educators, and others supporting the childbearing cycle could be accused of practicing midwifery without a license.

These bills address the concerns of Hawaii, Kauai, and Maui county councils urging the permanent exemption of birth attendants.

These bills address concerns arising from the United Nations and WHO regarding culturally appropriate care led by midwives and community based birth practitioners, to improve the maternal and infant mortality rates that have been climbing since 2000.

These bills address harm reduction by decriminalizing birth attendants which allows for collaborative care and open communication between various providers. This important step makes it safer for families to choose where and with whom they choose to birth their children without fear of persecution for themselves or those they choose to serve them during this tender time in their life.

These bills protect personal autonomy and self determination for the birthing person.

LEGISLATIVE UPDATE 2023

JANUARY 25, 2023

Senate Bill 1047 was introduced 1/20/2023 by Senator Maile Shimabukuro and passed the 1st reading on 1/23/2023. The companion bill HB 955 was introduced by Natalia Burdick-Hussey and passed the 1st reading on 1/25/2023. These two bills are aimed at providing an additional way to midwifery licensure as recognized by NARM (North American Registry of Midwives), the Certified Professional Midwifery Certification Board in addition to preserving permanent legal protection for Hawai’i’s beloved and long respected “Traditional Birth Attendants”. In the passing of these bills, we continue to honor the many ways families choose to bring their babies into this world.

You can help make a difference by going to the “Take Action” page!

Legislative update 2022

January 25, 2022

Senate bill #2661, has been introduced by Senators Maile Shimabukuro, Laura Acasio, Bennette Misalucha, and Clarence Nishihara on January 24, 2022 and a hearing has been scheduled for January 28, 2022 at 1pm via video conference. Meanwhile, the House of Representatives companion bill is being drafted in our midst. These bills are our continued crusade to help protect Traditional and Indigenous Practices that are vanishing globally. Please consider taking the time to thank our Senators for proposing this law, in addition to contacting your own local Senator to let them know how important the conservation of this knowledge is for our future generations.

On August 27, 2021, ACOG and ACNM released a joint statement publicly apologizing for their active and methodical degradation, racial discrimination, and criminalization of the practice Traditional Midwifery in the United States. This has lead to the current status of American Obstetrics and the continued over medicalization of modern midwives. The apology is timely considering HIHBC has been thoughtfully educating our legislative body about how critical this recognition is for the past several years.

The shocking history of Obstetrics was built on experimentation on black and brown women for the sake of “science and advancement”. This has come alongside the smearing of traditional healers and midwives, nearly eradicating the practices altogether in favor of the medical, industrial, profit driven, capitalist model of maternity care. Vice President Kamela Harris has publicly shed light on the disparities facing American Women today stating that “Maternal mortality and morbidity is a serious crisis in our country. Women are dying at a higher rate than any other developed nation in the world.” These disparities are NOT because 1 - 2% of families are choosing to birth at home, and certainly not because of fraction of those are choosing a Traditional Practitioner.

As more and more information is being shared with the public, we cannot continue to suppress the facts. HIHBC and the Hawai’i Home Birth Task Force has completed months of collaborative research alongside DOH, DCCA, HHA, and ACOG to PROOVE that choosing a home birth with skilled Traditional Midwives and Birth Attendants ARE a safe option for Hawai’i’s families.

NOW IS THE TIME TO ACT TO PRESERVE AND PROTECT!

Legislative Update 3/1/21

February 19, 2021 was the last day SB893 was able to get a hearing. Senator Jarrett Keohokole stated on February 11, 2021 that he would not schedule a hearing on this bill because “Midwifery Licensure was an intensely controversial issue when the legislature took action on it two years ago…. I do intend to work on this issue in the interim, and am willing to meet with you to discuss this.” Many thanks for Senator Keohokaole for being willing to address it and recognizing there is still work to be done!

We need community members to LOBBY from now and through next legislative season. You can find YOUR legislator by following the link below.

If each of our members takes the time to send one email, set up one phone call, or find another way to reach out to their own legislators to gently RE-educate them about Midwifery in Hawaii, then they will have the information and the curiosity before the 2022 legislative season arises. They won’t feel pressured to figure it all out in a short period of time. Many of our legislators already know this is a controversial topic, but many do not know WHY! As a community, and also as individuals within their communities, we have the ability to turn their ear towards the truth in the statistics collected by the Hawaii Home Birth Task Force from 2019-2020. We can help demystify the confusion, the fear, and the controversy surrounding this subject and follow what the community is actually asking for.

Legislative Update 2/1/21

HIHBC.ORG is dedicated to the preservation of the diversity of Midwifery practices in the State of Hawaii. This year, we are presenting the Hawaii State Legislature with SB893 to ensure Traditional and Cultural Midwives/Birth Attendants practices remain lawful alongside the already licensed Midwives. This bill was drafted based upon the findings of the Hawaii Home Birth Task Force, as directed in ACT 32 which passed legislation in 2019.

The timing of this bill coordinates with the impact COVID-19 has had on our birthing families. More than ever, families are choosing to birth in their home, rather than in a hospital setting. Based on the facts collected by the Home Birth Task Force, it is appropriate for the state legislature to recognize and protect the many Traditional and Cultural Midwives/Birth Attendants being sought out for services in our great state. The clarification of terminology and scopes of practice laid out in SB893 allows women to choose safe and culturally appropriate care for themselves and their babies.

As a member of HIHBC, you are encouraged to read the bill posted below and contact your local legislators in order to educate and build support for SB893. The community receiving services from a Traditional or Cultural Midwife/Birth Attendant may be the minority, but their choices must be protected and held just as sacred as those choosing a more medicalized model of care. The preservation of these practices perpetuates the acknowledgment of vanishing cultural practices worldwide. We have the opportunity to protect and honor tradition and to set an example for the world to see.

SB 893 has the full support of the Maui County Commission on the Status of Women! See their statement below!

SB893
FIRST LEGISLATURE, 2021
STATE OF HAWAII

RELATING TO MIDWIVES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

A BILL FOR AN ACT

SECTION 1. Section 457J-2, Hawaii Revised Statutes, is amended as follows:

1. By adding four new definitions to be appropriately inserted and to read:

""Direct-entry midwife" means an independent practitioner educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school, college, or university-based program distinct from the discipline of nursing and who is trained to provide the midwives model of care to healthy women and newborns throughout the childbearing cycle, primarily in out-of-hospital settings.

"Licensed midwife" means a person licensed under this chapter.

"Midwifery model of care" means monitoring the physical, psychological, and social well-being of a birthing parent throughout the childbearing cycle; providing them with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support; minimizing technological interventions; and referring birthing persons who require obstetrical attention.

"Traditional midwife" means an autonomous midwife who has acquired the skills to care for pregnant people, babies, and their families throughout pregnancy, birth, and postpartum through a spiritual or cultural lineage, is recognized nationally and internationally by the Midwifery Education Accreditation Commission and Midwifery Alliance of North America, and does not advertise as a certified or licensed midwife."

2. By amending the definition of "qualified midwife preceptor" to read:

""Qualified midwife preceptor" means [a] an exempt or licensed and experienced midwife, or other maternal health professional licensed in the State, who participates in the clinical education of [individuals enrolled in a midwifery education program accredited by the Midwifery Education Accreditation Council or Accreditation Commission For Midwifery Education and who meets the criteria for midwife preceptors set forth by the applicable organization.] midwives."

3. By deleting the definition of "midwife":
[""Midwife" means a person licensed under this chapter."]

SECTION 2. Section 457J-3, Hawaii Revised Statutes, is amended to read as follows:

"[[]§457J-3[]] [Midwives] Midwife licensing program. There is established a [midwives] midwife licensing program within the department to be administered by the director.

SECTION 3. Section 457J-4, Hawaii Revised Statutes, is amended to read as follows:

"[[]§457J-4[]] Powers and duties of the director. In addition to any other powers and duties authorized by law, the director shall have the power and duties to:

(1) Grant permission to a person to use the title of ["midwife" or] "licensed midwife" and engage in the practice of midwifery in this State pursuant to this chapter and the rules adopted pursuant thereto;

(2) Adopt, amend, or repeal rules pursuant to chapter 91 to carry out the purposes of this chapter;

(3) Administer, coordinate, and enforce this chapter and rules adopted pursuant thereto;

(4) Discipline a licensee for any cause described by this chapter or for any violation of rules or refuse to license a person for failure to meet the licensing requirements or for any cause that would be grounds for disciplining a licensee;

(5) Appoint an advisory committee to assist with the implementation of this chapter and the rules adopted pursuant thereto. The advisory committee shall consist of the following:

(A) Three midwives who are certified professional [midwives or certified] midwives;
(B) Two members of the public; and
(C) A certified [nurse] midwife[;], if available; and

(6) Add, remove, or otherwise modify the authorized non-controlled legend drugs and legend devices listed in 457J-11 by rule under chapter 91."

SECTION 4. Section 457J-5, Hawaii Revised Statutes, is amended to read as follows:

"[[]§457J-5[]] License required. 

(a) Beginning July 1, 2020, except as provided in this chapter, no person shall [engage in the practice of midwifery, or] use the title ["midwife",] "licensed midwife"[,] or the abbreviation "L.M.", or any other words, letters, abbreviations, or insignia indicating or implying that the person is a licensed midwife without a valid license issued pursuant to this chapter
(b) Nothing in this section shall preclude a person holding a national certification as a midwife from identifying the person as holding such certification, so long as the person is not [practicing midwifery or] professing to be [authorized to practice midwifery in the State] a licensed midwife unless that person is licensed in accordance with this chapter."

SECTION 5. Section 457J-6, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:

"(a) A person may practice midwifery without a license to practice midwifery if the person is:

(1) A certified nurse-midwife holding a valid license under chapter 457;
(2) Licensed and performing work within the scope of practice or duties of the person's profession that overlaps with the practice of midwifery;
(3) A student midwife who is currently enrolled in a midwifery educational program under the direct supervision of a qualified midwife preceptor;
(4) A person rendering aid in an emergency where no fee for the service is contemplated, charged, or received; or
(5) A person acting as a [birth attendant on or before July 1, 2023,] direct-entry midwife, who:

(A) Does not use legend drugs or devices, the use of which requires a license under the laws of the State[;], with the exception of oxygen and a department of commerce and consumer affairs, approved anti-hemorrhagic agent;
(B) Does not advertise that the person is a licensed midwife;
(C) Discloses to each client verbally and in writing on a form adopted by the department, which shall be received and executed by the person under the [birth attendant's] direct-entry midwife's care at the time care is first initiated:

(i) That the person does not possess a professional license issued by the State to provide health or maternity care to women or infants;
(ii) That the person's education and qualifications have not been reviewed by the State;
(iii) The person's education and training;
(iv) That the person is not authorized to acquire, carry, administer, or direct others to administer legend drugs;
(v) Any judgment, award, disciplinary sanction, order, or other determination that adjudges or finds that the person has committed misconduct or is criminally or civilly liable for conduct relating to midwifery by a licensing or regulatory authority, territory, state, or any other jurisdiction; and
(vi) A plan for transporting the client to the nearest hospital if a problem arises during the client's care; and

(D) Maintains a copy of the form required by subparagraph (C) for at least ten years and makes the form available for inspection upon request by the department.

(b) Nothing in this chapter shall prohibit healing practices by [traditional]:

(1) Traditional Hawaiian healers engaged in traditional healing practices of prenatal, maternal, and child care as recognized by any council of kupuna convened by Papa Ola Lokahi[.]; or
(2) Traditional midwives as defined in section 457J-2. Nothing in this chapter shall limit, alter, or otherwise adversely impact the practice of traditional Native Hawaiian healing pursuant to the Constitution of the State of Hawaii."

SECTION 6. Section 457J-8, Hawaii Revised Statutes, is amended by amending the title to read as follows:

"[[]§457J-8[]] Application for license as a licensed midwife."

SECTION 7. Section 457J-11, Hawaii Revised Statutes, is amended as follows:

1. By amending subsection (a) to read: "(a) A licensed midwife licensed under this chapter may purchase and administer non-controlled legend drugs and devices that are used in pregnancy, birth, postpartum care, newborn care, or resuscitation, and that are deemed integral to providing care to the public by the department."
2. By amending subsection (d) to read: "(d) A pharmacist who dispenses drugs and devices to a licensed midwife as authorized by this section and in conformity with chapter 461 is not liable for any adverse reactions caused by the licensed midwife's administration of legend drugs and devices."

SECTION 8. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 9. This Act shall take effect upon its approval.

"INTRODUCED BY: _____________________________

Report Title:

Midwives; Licensure; Direct-entry Midwives; Traditional Midwives; Exemption

Description:

Amends various provisions related to the licensure of midwives. Allows direct-entry midwives to practice midwifery under certain conditions.

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.