SB1047

SECTION 1. The legislature finds that Act 32, Session Laws of Hawaii 2019, (Act 32) established a three-year period to allow birth attendants to define and develop common standards, accountability measures, and disclosure requirements, with the intent that at the end of the three-year period the legislature would adopt further legislation to establish a pathway for traditionally-trained, non-certified birth attendants to legally practice in Hawaii.

However, the legislature recognizes that there are other types of birth attendants who are not covered by the Native Hawaiian midwife exemption through Papa Ola Lokahi, and that neglecting to exempt other cultures from stringent, westernized licensing requirements predominantly disenfranchises people of color. The legislature further recognizes that traditionally-trained birth attendants of all cultures are valued and preferred by some consumers and that the type of birth attendant utilized at a birth should be the birthing person's choice. All birthing parents should have the right to choose their preferred birth attendant.

Act 32 was originally drafted based on Oregon law, but the Hawaii law is missing a critical exemption that would allow licensed midwives to practice midwifery while still providing culturally appropriate birthing care by individuals who are not licensed. Under section 687.415 of the Oregon Revised Statutes, a person can practice direct entry midwifery without a license if that person does not use legend drugs and devices, does not advertise as a midwife, and provides a board approved disclosure statement to every client. Although the Hawaii law contains similar provisions, the exemption is limited only to persons acting as a birth attendant on or before July 1, 2023.

The legislature further finds that Act 32 inadvertently omitted a category of certified professional midwives who are certified by the North American Registry of Midwives but are ineligible for licensure in Hawaii. The North American Registry of Midwives offers two pathways to the certified professional midwife certification: completing an independent course of study and the North American Registry of Midwives portfolio evaluation process, known as the PEP pathway; and completing a course of study at a Midwifery Education Accreditation Council accredited school, known as the MEAC pathway. Both pathways require apprenticeship as well as acquisition of the same knowledge base, confirmed by passing the same standardized test. As there are no Midwifery Education Accreditation Council accredited schools in Hawaii, the PEP pathway offers a more accessible way for midwifery students in the State to obtain certification as certified professional midwives. As it stands, only certified professional midwives candidates who have taken the MEAC pathway to certification are able to pursue licensure in Hawaii. Inclusion of the PEP pathway in the licensure process would rectify this oversight.

In midwifery, the certified professional midwives model of care is only one of many. People of every faith, cultural practice, and family lineage give birth. Since the beginning of time, humans have developed nuanced birth beliefs and practices. The type of midwifery provided by certified professional midwives meets the needs of some, but not all, birthing parents. More traditional models fill the gap by meeting needs which are not met by obstetric or certified professional midwives care. All models are still in demand, which has been demonstrated repeatedly through large amounts of public testimony supporting uncertified birth attendants.

Even within the State, maternal mortality outcomes are significantly lower for Black, Filipino, Native Hawaiian, and Pacific Islander birthing people. The fields of social science and public health are proving that respect, dignity, and personal accountability in health care decision making have a positive impact on outcomes.

A birthing person's ability to choose where to give birth, what model of care makes them feel safe, and who they want by their side providing that care are absolutely integral to safety, bodily autonomy, happiness, and comfort during birth.

The purpose of this Act is to:

(1) Permit persons acting as birth attendants after July 1, 2023, to practice midwifery without a license; and

(2) Include the North American Registry of Midwives portfolio evaluation process as proof of a successful completion of a formal midwifery education and training program for certified professional midwives.

SECTION 2. This Act shall be known as "Sovereign's Law" in honor of a twelve-year-old Native Hawaiian adolescent who aspires to be a traditionally-trained midwife, to preserve the practice and legal pathway of traditional midwifery for future generations in Hawaii.

SECTION 3. Section 457J-6, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"[[]§457J-6[]] Exemptions. (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~~] under the supervision of a North American Registry of Midwives qualified [~~midwife~~] preceptor[;] or a Midwifery Education Accreditation Council qualified 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,~~] who:

(A) Does not use legend drugs or devices, the use of which requires a license under the laws of the State;

(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 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."

SECTION 4. Section 457J-8, Hawaii Revised Statutes, is amended to read as follows:

"[[]§457J-8[]] Application for license as a midwife. To obtain a license under this chapter, the applicant shall provide:

(1) An application for licensure;

(2) The required fees;

(3) Proof of current, unencumbered certification as a:

(A) Certified professional midwife; or

(B) Certified midwife;

(4) For certified professional midwives[~~, proof~~] either:

(A) Proof of a successful completion of a formal midwifery education and training program that is either:

[~~(A)~~] (i) An educational program or pathway accredited by the Midwifery Education Accreditation Council; or

[~~(B)~~] (ii) A midwifery bridge certificate issued by the North American Registry of Midwives for certified professional midwife applicants who either obtained certification before January 1, 2020, through a non-accredited pathway, or who have maintained licensure in a state that does not require accredited education; or

(B) A person who:

(i) Has obtained certification through the North American Registry of Midwives portfolio evaluation process;

(ii) Holds a midwifery bridge certificate issued by the North American Registry of Midwives for certified professional midwives; and

(iii) Has a current cardiopulmonary resuscitation certification for adults and newborns and for neonatal resuscitation;

(5) If applicable, evidence of any licenses held or once held in other jurisdictions indicating the status of the license and documenting any disciplinary proceedings pending or taken by any jurisdiction;

(6) Information regarding any conviction of any crime which has not been annulled or expunged; and

(7) Any other information the department may require to investigate the applicant's qualifications for licensure."

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	1047
THIRTY-SECOND LEGISLATURE, 2023
STATE OF HAWAII