Hawaii House passes midwifery licensing bill after heated debate over cultural exemptions

The Hawaii House of Representatives on final reading approved HB 1194 HD2 SD3, a bill to establish professional standards and licensing pathways for midwives and to remove the sunset on the state's midwifery law, after extended floor debate and a 34-16 roll-call vote.

Supporters said the measure creates clearer training, a portfolio evaluation pathway (PEP) and a bridge certificate for licensure while explicitly exempting Native Hawaiian traditional and customary birthing practices; opponents said the bill still risks limiting cultural and religious birthing choices and could prompt further litigation.

Representative Todd moved to agree to the Senate amendments and to place the bill on final reading; Representative Morikawa seconded. The House then took votes to agree to the Senate amendments, to suspend the rules for final reading by consent, and on final passage of the bill. After floor debate and a roll-call requested by Representative Cochran, the clerk recorded 34 ayes and 16 noes, and the bill passed final reading.

The Senate amendments and floor discussion amended the bill in three areas that sponsors and supporters described on the floor: adding a portfolio evaluation process (PEP) as a pathway to licensure, creating a bridge certificate to facilitate licensure in Hawaii, and adding an exemption allowing persons invited by a patient to be present at a birth so long as they do not use the title "midwife" or engage in regulated midwifery practice. The bill's text also states nothing in the measure establishes a criminal penalty; however, supporters acknowledged that administrative fines and fees for violations would remain in place.

Representative Takayama, speaking in support, described the bill as the product of "many, many hours of hearings and debate" and said it "preserves the constitutional right of native Hawaiians to exercise traditional and customary practices regarding childbirth." Takayama and several other supporters said the bill also removes the sunset on the earlier statutory framework and implements licensing steps recommended by prior auditors.

Opponents voiced several recurring concerns on the floor. Representative Cochran, who identified a global delegation of indigenous midwives in the gallery, said the measure as written would effectively restrict who can provide cultural midwifery and warned of significant financial penalties, saying the bill could subject traditional practitioners to "heavy fines" and that "this is not a choice. This is not freedom of choice." Multiple other representatives objected to what they described as insufficient religious and cultural exemptions beyond the protection explicitly called out for Native Hawaiian practices under Article XII, Section 7 of the Hawaii Constitution.

Some members said they supported the bill with reservations. Representative Amato said the measure balanced public safety and cultural rights but warned the teaching/preceptorship pathway could "limit opportunity for licensure for teachers" and could revive ongoing legal challenges. Representative Shimizu and others said they feared the measure could be seen as limiting the freedom to choose culturally rooted birth attendants.

Supporters noted safeguards in the Senate amendments and emphasized that the bill narrows the statutory definition of "practice of midwifery" (as described on the House floor) to exclude lactation consultants, doulas and persons practicing Native Hawaiian traditional and customary practices. Representative La Chica, among supporters, cited a state audit and said certain births in some populations were covered by Medicaid (her remarks referenced a figure of about 45 percent in related contexts) and argued those families deserved access to regulated, trained providers and accountability.

After the roll-call, the clerk announced the result: 34 ayes, 16 noes. Members on both sides of the debate asked to insert written comments into the House journal; several members requested that remarks from colleagues be entered into the record.

HB 1194 HD2 SD3 passed final reading and will proceed according to legislative process (the transcript does not specify post-passage steps).