House adopts midwifery licensing bill after failed floor amendment and extensive debate

The Hawaii House of Representatives debated House Bill 11 94 (House Draft 2), a measure to revise licensing and scope-of-practice standards for midwives, including provisions addressing traditional Native Hawaiian practices and exemptions.

Rep. Belotti introduced a floor amendment that he said ‘‘makes 3 substantively important changes’’ — adding a religious-exemption provision, reinstating an exemption for traditional birth attendants while adding consumer-protection language, and creating a portfolio-evaluation pathway (PEP) to credential locally trained midwives. The amendment drew extended discussion on constitutional protections, consumer safety, and access to licensure for practitioners trained in Hawaii or through apprenticeships.

Supporters, including Representative Belotti and several members who spoke in favor, argued the amendment and the bill would protect customary practice, expand local pathways to licensure, and avoid unduly excluding Hawai‘i-born and community-trained midwives. Representative Peruso said the amendment and bill would ‘‘remove some barriers’’ and support locally trained midwives practicing in rural areas. Representative Iwamoto and others stressed that the portfolio-evaluation pathway would allow Hawaii residents who train locally to obtain licensure.

Opponents, including Representatives Takayama, Ichiiyama and others, cited the state auditor’s recommendations and raised concerns that broad exemptions or alternative pathways could undercut standards intended to protect maternal and neonatal health. Rep. Ichiiyama asked members to consider the auditor’s sunset review (audit report number 25-03) and the policy that regulation should be undertaken ‘‘only where reasonably necessary to protect the health, safety, or welfare of consumers of the services.’’ Some members warned that a broad ‘‘birth attendant’’ exemption without clear standards could leave consumers without needed protections or recourse.

The House held a roll-call vote specifically on the proposed floor amendment; the amendment failed, 15 ayes, 34 noes, 2 excused. (Clerk count reported: 15 ayes, 34 noes, 2 excused.) Debate continued on the underlying bill. Members gave both personal testimony and inserted written comments into the journal; multiple speakers recounted cases and clinical concerns observed by hospital staff, and advocates described cultural and access issues for rural families.

Later in the afternoon the House proceeded with final business; House Bill 11 94 (HD 2) was listed on the calendar and received third reading: the clerk’s subsequent floor tally recorded dissenting members from the minority and several majority members. The record shows multiple members voting in opposition, but the measure proceeded through third reading as part of the bundle of bills taken that day.

Why it matters: HB 11 94 affects where and how mothers in Hawaii can receive out-of-hospital birth care, whether Native Hawaiian customary and religious birth practices are explicitly protected, and how the state balances access, cultural practice, and consumer protections for maternal and newborn safety.

What’s next: The measure moved off the House floor after third reading; any further changes would occur if the Senate amends it or during conference if the Senate acts differently.