LIHU‘E — A group of women gathered at the Kaua‘i County Council chambers on Wednesday to advocate for shielding birth attendants from new state licensing requirements.
The council was considering Resolution No. 2023-31, which voices support for a highly publicized midwife regulation bill at the state Legislature.
House Bill 995 stems from a 2019 measure, Act 32, that gave the state until June 30, 2023, to determine licensing standards for traditional birth attendants.
The bill would allow birth attendants to qualify for licensure through the hands-on North American Registry of Midwives Portfolio Evaluation Process, or PEP, rather than the more formal Midwifery Education Accreditation Council process, and exempts those who were acting as birth attendants before July 1, 2025, from new licensure requirements.
If the bill does not pass this session, some birth attendants not registered under the MEAC process may no longer be allowed to practice by July.
“I brought this resolution because I saw what may potentially happen — potential birthing moms will lose access to care and have a higher risk of not getting the attention they need,” said Council Member and Chiropractor Addison Bulosan, who introduced the resolution.
Mieko Stewart, a licensed midwife on Kaua‘i, said she feared she would lose her assistants if the measure did not pass.
“They do a lot of the setup and support of the families. Doing it by myself would increase the stress, and would take away another set of eyes and hands,” Stewart testified on Wednesday.
She emphasized the importance of allowing traditional birth attendants to learn through hands-on practice.
“One of the best ways they learn is through direct experience — sitting with women in times of their biggest challenges,” Stewart said.
There is debate over how broadly the bill would affect traditional birth attendants, with some saying that the licensure requirements would increase safety for mothers that choose home births while having a limited impact on traditional birth attendants.
“Licensure of midwives was critical to making community (or out of hospital) births in Hawai‘i safer,” wrote Angel M. Willey of the Hawai‘i Section of the American College of Obstetricians and Gynecologists, in testimony to the state Legislature.
“Licensure of midwives was also important for future efforts at promoting a more integrated maternal health care system, similar to those seen in western Europe where maternal and neonatal outcomes exceed those in the U.S.”
Testifiers at Kaua‘i County Council on Wednesday — International Women’s Day — framed the matter as an issue of female reproductive rights.
“Women do not want to have their rights taken away if they want to choose a regulated birth attendant,” said Hawai‘i Home Birth President Kristie Duarte.
When the bill passed, it was generally assumed that additional pathways for licensure would be added, she said.
“I am doing the PEP route to become a (Certified Professional Midwife), and would love nothing more than to be viewed as competent like my fellow student midwife friends, who are doing the MEAC school route,” said Gianny Navas in submitted testimony, adding that both are required to take the same entrance exam.
The measure has generated protests at the state Capitol, and sparked similar resolutions in the Maui and Hawai‘i Island county councils.
The Kaua‘i County Council resolution ultimately passed in a 5-1 vote, but the House bill may be dead in the water regardless.
It did not pass the House by the crossover deadline on Tuesday, after it was not scheduled for a public hearing by the Finance Committee. While it could have been revived if one third of representatives vote on the floor by Thursday, March 9, this had not occurred as of 3:30 p.m., according to the state Legislature’s website.
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Guthrie Scrimgeour, reporter, can be reached at 808-647-0329 or gscrimgeour@thegardenisland.com.
