There has been a stir recently regarding the midwifery law (HRS 457-J) and a perception that allowing an exemption to expire on June 30, 2023, will eliminate cultural practices and traditional birth attendants. That’s not true.

The midwife licensure law, HRS 457-J, does not erase the ability of birth workers to practice, nor does the law restrict a family’s right to choose where and with whom they wish to birth.

What will happen on July 1 is that the state will no longer condone the unregulated practice of midwifery. On July 1, any person practicing midwifery must be licensed as a midwife.

What this means is that the licensed naturopaths who attend births and sell their service to clients as midwifery will have to be clear instead that they are selling naturopathic services. Registered nurses who attend births as primary birth attendants who sell their services as midwifery will need to be clear they are providing birth services, not nursing or midwifery services. (Registered nurses are not independent primary healthcare providers.)

Traditional birth attendants and cultural practitioners who provide birth services can continue to practice the same as they do today on July 1, as they are both undefined and unregulated professions that are distinct from midwifery.

The difference is that they will no longer be able to sell their services to clients as midwifery. Clients who hire licensed naturopaths, registered nurses, traditional birth attendants, and/or cultural practitioners are experiencing something different in their care than midwifery.

These providers are not trained in midwifery, and that’s OK. Families desire a variety of options for birth services, and we support them having these options.

What can be confusing about the current rallies is that there is a perception that if a person is birthing at home they must be birthing with a midwife, and that is untrue. There are many different providers, including midwives, they can choose from to attend their birth and we support that.

Further confusing the issue is the perception that the midwife law, HRS 457-J, impacts women’s body autonomy, birth sovereignty, and women’s right to choose how and where they birth and with whom.
Yet this is not in question nor regulated by HRS457-J because the midwife licensure law doesn’t regulate home or hospital birth or people’s right to make choices for themselves.

HRS 457-J also does not impact traditional Hawaiian healers ability to engage in Native Hawaiian healing practices because it is not for the profession of midwifery to have any say in Native Hawaiian healing practices — these are protected in the Constitution of the state of Hawaii.

Legislative Omission

It might surprise you to know that Hawaii doesn’t have an overarching law requiring health-care providers to be licensed to practice and sell their services and to obtain and administer medications — so midwives did this without oversight for 21 years. Hawaii had regulated the practice of midwifery between 1931-1998 but a legislative omission in 1998 resulted in anyone being able to practice midwifery and sell their services without a license, along with advertising as a midwife.

Our organization has continued to provide education to legislators that the profession of midwifery should be regulated for the safety of consumers and our community.

In 2019, the Legislature and governor passed into law what became HRS 457-J. This law says all midwives must be licensed in order to practice midwifery.

Legislators included a four-year exemption that allows for anyone to practice the profession of midwifery and sell their services without being licensed until June 30. This was an interesting exemption because the state specifically condoned the unregulated practice of a now regulated profession.

It also created a misunderstanding in the public that birth attendants were providing midwifery services to clients, rather than that the state merely allowed people to sell services under the title of midwifery when the consumer was not receiving midwifery services.

Our organization supports and promotes midwifery as a standard of care for women, and the intrinsic right of birthing people to birth as they choose. We support cultural practitioners, traditional birth attendants and others to practice as they choose, which is freely available in Hawaii as there is no definition of these different titles, nor regulation of these practices.

Being present at a birth is not the definition of a midwife. All birth workers can continue to practice, and all consumers can choose who they wish to have at their birth.