Finance committee hears hours of testimony on bill to license midwives; decision deferred

The House Committee on Finance heard extensive testimony and legal comment on HB 11-94, HD1 — a bill to establish licensing and practice standards for non‑nurse midwives in Hawaii — and postponed a final vote to allow members who missed the hearing to review the record.

The discussion on the bill, offered as a replacement framework for the 2019 midwifery law (Act 32), divided witnesses into two broad camps. Proponents — including medical groups and some licensed midwives — said a clear statutory licensure framework, continuing education and peer review would improve patient safety and expand equitable access to care. Opponents, including many traditional and community midwives and consumer advocates, said the draft would exclude customary practitioners and cut off a widely used apprenticeship pathway that currently produces many practicing certified professional midwives (CPMs).

Supporters argued that licensing would create a single, transparent standard for consumers and make it easier for midwives to join Medicaid and insurance panels. "Licensed midwives need to be authorized in the statute," said Margaret Reagan, dean of the UH School of Nursing and Dental Hygiene and a leader with the Hawaii affiliate of the American College of Nurse‑Midwives. She and other supporters urged peer review, mandatory neonatal‑resuscitation and CPR certification and submission of outcome data so regulators and hospitals can monitor quality.

Opponents said the bill, as drafted, would have the opposite effect by criminalizing many traditional birth attendants and excluding midwives who attained CPM status via the portfolio evaluation (PEP) route rather than an accredited school. "This is the chance that the House can do what it said and intended it would do: end criminalization of our traditional and cultural practitioners," said Christie Dort, president of the Hawaii Home Birth Collective, which submitted a set of amendments intended to preserve cultural exemptions and preserve the PEP/portfolio option.

Legal and administrative issues also featured in the hearing. The Department of the Attorney General and the Department of Commerce and Consumer Affairs (DCCA) raised questions about delegation of authority and the mechanics of implementation. Deputy Attorney General Chelsea Okamoto told the committee the bill should not hand "unfettered discretion" to a private standards body and recommended targeted statutory changes — for example, to clarify the interaction with county ordinances that impose flavor bans in other contexts. DCCA staff said the department could not yet commit to running new credential verification processes without clearer statutory language and timelines.

A number of witnesses described difficult personal experiences: both parents and clinicians described births that resulted in transfer to hospitals and poor outcomes; others described trauma in hospital settings that drove them to seek out home birth or community‑based care. Pediatricians and obstetricians who testified in support of the bill stressed that some adverse outcomes arrive at the hospital after an unrecognized problem at home, and asked the committee to adopt minimum education/certification and data reporting so serious events can be tracked.

The debate centered on several key policy choices: whether to require attendance at MEC‑accredited midwifery schools for licensing, or to preserve the NARM portfolio (PEP) route used by many current CPMs; what continuing education and peer‑review requirements are appropriate; whether licensed midwives should hold limited prescriptive authority; and how to define and protect traditional and cultural practitioners under the Hawaii Constitution.

Quotes that capture the range of testimony: "End criminalization of our traditional and cultural practitioners," said Christie Dort of the Hawaii Home Birth Collective. "County flavor bans are called 'trigger bans,'" Deputy Attorney General Chelsea Okamoto told the committee when describing how county ordinances could interact with statewide rules. "Licensed midwives need to be authorized in the statute," said Margaret Reagan of the UH affiliate of the American College of Nurse‑Midwives.

At the close of the hearing the committee deferred a vote to a later date so members who were absent could participate in decision making and so staff could review the large record. Committee staff indicated they expect additional amendments and further legal work — including clarifications DCCA requested — before coming back for a final recommendation.

What’s next: the bill remains under consideration; the committee said it will reconvene for decision making after members have had a chance to review the hearing record and the auditor’s pending report on the 2019 law. Because the measure touches licensing, public safety, cultural rights and potential litigation, it is likely to proceed slowly and to require negotiated amendments before it moves to the full House.