Hawaii hearing on HB1194 exposes split between calls for accredited midwifery training and protections for traditional, apprenticeship pathways

The Senate Committee on Health and Human Services heard testimony May 16 on HB1194 HD2, a bill to revise licensure and regulation of midwives in Hawaii, with public commenters sharply divided over whether the measure should require accreditation-based education or preserve apprenticeship and cultural exemptions.

The Department of Commerce and Consumer Affairs, represented at the lectern by Alexander Pang, executive officer for DCCA’s midwives program, told the committee it had submitted written testimony and was available for questions. "We stand on our written testimony and are available for questions," Pang said.

Why it matters: the bill would change who can be licensed and what education counts toward licensure in a state where many families rely on home- and community-based midwifery, and where speakers said access and cultural practice are at stake. More than 900 people filed written testimony and dozens of residents, midwives, nurses and doctors delivered one-minute oral comments during the hearing that stretched across islands and Zoom.

Supporters, including several medical groups and some practicing clinicians, said the bill would raise and clarify professional standards. "The American College of Obstetricians and Gynecologists strongly supports HB1194," said Dr. Ricardo Molero Bravo of ACOG, urging passage "with no amendments" and arguing that accredited education can improve maternal and newborn safety. Dr. Ronnie Teixeira, chief of obstetrics at Straub Medical Center in Kaneohe, testified that the bill "requires midwives to complete an accredited educational program and upholds the gold standard of midwifery training." Dr. Cassandra Simonson, a pediatrician on Maui, said she supported the bill as a way to reduce preventable newborn harm: "This bill helps do that."

Opponents — a coalition of traditional and apprenticeship-trained midwives, doula organizations, Native Hawaiian and other cultural practitioners, and civil-rights groups — urged major revisions. Many speakers said the bill as drafted would criminalize long-standing cultural birth practices and exclude the Portfolio Evaluation Process (PEP), an apprenticeship route used in Hawaii. "This bill does not expand access. It takes it away," said Nicole Kalegas, a licensed CPM and Maui-based midwife. Testimony from representatives of the Midwives Alliance of Hawaii, NARM (the North American Registry of Midwives), and dozens of individual traditional practitioners emphasized that the PEP pathway allows locally trained midwives to serve rural and indigenous communities.

Key points of debate

- Education and credentialing: The bill’s supporters argued for a requirement that midwives complete an MEC-accredited educational program and obtain recognized credentials so that licensed midwives meet uniform professional standards. Opponents said NARM-recognized pathways, including PEP and NARM’s bridge/portfolio processes, should remain available and that requiring out-of-state MEC attendance would be a financial and logistical barrier.

- Cultural and religious exemptions: Multiple witnesses warned that the bill’s existing exemptions were vague and would not reliably protect Native Hawaiian, Pacific Islander and other cultural birth practitioners. Testifiers asked the committee to reinstate or clarify an explicit birth-attendant exemption used previously and to add stronger language protecting traditional, religious and familial roles in birth.

- Criminalization and access: Hundreds of opponents said the bill risks criminalizing grandmothers, kupuna and traditional attendants who are asked by families to attend births; speakers repeatedly tied that risk to reduced willingness to transfer to hospitals when needed, for fear of legal consequences.

- Consumer protection vs. reproductive autonomy: Supporters framed licensure as a public-safety and quality measure; opponents framed restrictive licensure as an erosion of reproductive autonomy and an inequitable barrier for local, community-based midwives.

Committee procedure and next steps

The hearing was primarily public testimony and included department and organization representatives. The committee recessed at the end of the session and said it will reconvene for decision making at 1 p.m. Monday, May 17, 2025, in Room 225. There were no final committee votes recorded at the hearing.

Voices from the hearing

- Annette Manard, president of the Hawaii affiliate of the American College of Nurse Midwives, told senators her group "supports a comprehensive bill to move forward that is complete in supporting the practice of midwifery by the certified midwife" and emphasized improving maternal and newborn health.

- Leah Minton, board president of the Midwives Alliance of Hawaii, urged passage with amendments to protect pathways and cultural practices and said, "We testify in strong support of HB1194 HD2 as is with no amendments" (she also asked the committee to ensure standards referenced the correct credentialing frameworks).

- Rebecca Stewart Botello, a veteran doula and apprenticing midwife, urged the committee to "vote no on HB1194 unless it protects all birth choices," saying traditional midwifery has "extraordinary efficacy and safety," a view echoed by many opposition speakers who described decades of community practice.

Clarifying details from testimony

- Written testimony: the committee chair noted more than 900 written submissions on the bill. - Pathways: witnesses repeatedly referenced the Portfolio Evaluation Process (PEP) and NARM certification as established routes to CPM status; supporters emphasized MEC-accredited education. - Statutory references: speakers cited Hawaii Revised Statutes provisions governing midwifery (often cited as HRS 457J) and prior legislative action (Act 32, 2019, the earlier midwifery law). - Postpartum care: a representative of the Hawaii Midwifery Council noted the draft reduces postpartum coverage in statute from eight weeks to six weeks and recommended increasing it to 12 weeks to improve continuity of care.

What the hearing did not resolve

The committee did not vote on HB1194 HD2 at the hearing. Lawmakers recessed until Monday’s decision-making session; sponsors and committee members signaled the bill will be discussed further and that members will consider amendments addressing the PEP pathway, cultural and religious exemptions, credentialing language, and consumer protections.

The question before senators is whether to require midwifery licensure that favors accredited, MEC-style education or to preserve apprenticeship and portfolio evaluation pathways commonly used in Hawaii — and, if the former, how to craft explicit cultural, religious and consumer-protection exemptions so families and traditional practitioners are not criminalized.

A follow-up decision-making session is scheduled for 1 p.m. Monday, May 17, 2025, in Room 225. The committee has the written testimony on file.