HomeMy WebLinkAboutCOM 0104.006 2022-2024 p/aoac.,
.51-23
COMM. 104
From: Adaure Dawson
Sent Friday, February 17, 2023 11:52 AM 's`► ?
To: Council Testimony a
IC Y.4
Subject: Regarding resolution 57-23
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Esteemed council members,
My name is Ezinne Dawson and I write this email to you all today and ask you stand in strong support of this resolution
57-23.
I am an unlicensed CPM, or, certified professional midwife, I trained to become a CPM under traditional midwives here .
in Hawaii. I began my training before this midwifery legislation was adopted. My training was done through the Portfolio
Evaluation Process(PEP). I attended about 100 births before I felt knowledgeable and prepared enough to sit for the
national NARM exam. I like many of my(MEAC) peers was trained on how to listen to a baby in utero, during the
prenatal period and specifically during labor, I like my(MEAC) peers was trained to know what is normal and what is out
of normal range for the fetal heart rate, I was trained to observe and asses maternal blood loss during and after labor
(like my MEAC peers), I was trained to know what is normal and what is not normal(same as my peers), I was trained to
respond with herbal remedies and with alternate western medicines. I know how to use both types medications, natural
and pharmaceutical (the same as taught to my MEAC peers). Unlike my peers I am INELIGIBLE for Licensure in the state
of Hawaii.
A valuable skill I learned during my training was to know how to listen to a laboring person and hear their needs yet also
communicate the importance of transferring to a hospital if the need to do so arises. It is not always the easiest decision
for a woman who wanted to birth at home to transfer to the hospital. It is helpful, if a relationship has been developed
over time,for there to be trust,thus a woman making that decision to transport to a hospital if necessary is more likely.
You we dont always know why a women would choose to not birth in the hospital and that is definitely not our business
to ask we know it's important that the birthed feels safe with her provider. ON that note do you know most OB's and
CNM's are not required to attend out of hospital birth? I've attended nearly 200 out of hospital births and honestly I've
probably attended more births in an individuals home than most OB's and hospital CNM's in Hawaii.A woman's labor at
home is a completely different experience than a woman's labor in the hospital. Imagine most staff in the hospital have
not witnessed truly un interrupted physiological birth and don't know how best to support a laboring woman in that
setting. Our traditional midwives/birth attendants, apprentice trained midwives and CPM's are truly experts in the field
of birthing at home.They have mastered the skill of in home support and have the wisdom to transport if an issue
becomes out of their scope. I myself have given birth multiple times 3X in a hospital and 2x at home. I have also
supported 100's of women both at home and in a hospital and the experience is always vastly different. Personally I
have experienced a number of uncomfortable/unpleasant hospital experiences and I would choose to birth 1000 more
times if I could. I'm certain I do not stand alone when I say that.
What makes the decision to go to the hospital harder for a laboring family? In my experience I have seen, lack of
compassion by the hospital receiving staff, lack of sufficient training for the EMS staff that is called in to transport,
criticism of the birthing woman, misjudgment of the birth attendant which leads to conflict and a host of other reasons.
Specifically, in the case of the birthing families living on big island, birth may require you to travel to another island to
deliver. None of these are enticing to walk into in the middle of a hard situation. I submit to you that the issue is not in
the lack of training of home birth practitioners but rather the lack of communication in transfer protocolsfromhome
to hospital. Comm.Mo. `tgb
1 Ref.To: 1'1l�O 1 c'
Ref.Date FFR 2 1 2023
The birth attendants I have worked with (and I have worked with many)all have the same goal a healthy mom and
healthy baby.We maintain certifications(CPR)and trainings(NRP)and protocols to ensure safety at the births we
attend to.We plan together with our families what to do, who to call and where to go in an emergency situation but we
do not know what to expect from the receiving providers and thus a broken link in the communication that is necessary
to ensure positive outcomes.
Again the breakdown may be be because most home birth attendants have such few transports to the hospital so when
it is time to actually utilize additional support and that support is not consistent nor compassionate it creates a rift and
brings challenges that make it harder on our families and babies. When time is of the essence we don't have time to
critique a mothers choice to birth at home coupled with the dismissal of the home birth provider who can give valuable
information to the receiving practitioner. Let me reiterate that these transport situations are rare but it seems these
situations are the ones that truly need to be highlighted and addressed because you will not hear from the birth
attendants and families that had beautiful and successful birth outcomes, (unless of course you challenge the ability for
these families to choose the provider of their choice and threaten to criminalize the people that truly made them feel
safe during their birth.)
I strongly urge you to support resolution 57-23 because it is not the providers of home birth that are causing the
issues. It is more likely the poor communication during transports that needs to be addressed. HB955 ensures access to
a variety of care providers and women and families are intelligent enough to choose a provider that best suits their
needs. I know that several families have declined care with me due to my lack of license even though I have the skill set
yet my inability to carry potential life saving meds (despite being trained to use them) is concerning. On the other hand
families have chosen me to support them as a traditional birth attendant based off of what they know and how they feel
about me.The Traditional birth attendants are definitely doing their part buy ensuring the people they work with
understand who they are by the use of a birth attendant form.That form of regulation fulfills the requirements set forth
in the Hawaii regulatory act.They have been defined, identified and simply asking to continue the work that they are
experts at so that consumers will still have them as an option.The Consumers have been asking for this choice
repeatedly.They know what they want.
Moms WILL continue to choose to birth their babies at home with our without support. My worry is if you reduce the
amount of people who are able to support families during their birth what will you say when you hear about a loss that
happened due to lack of assistance. Chances are that birthing individual has not attended hundreds or thousands of
birth to know that maybe what they are experiencing is not normal. It may be too late to get them the help needed. So
what next?Are you going to force every woman to birth in a hospital?Absolutely not.Address the issue not by
eliminating providers but by making sure the birth attendants remain legal.
At this weeks CPC hearing in Oahu in regards to HB955 there was some misconception about the Midwifery certificate
that is issued to CPM's by NARM,who is the national certifying body for certified professional midwives. I have a
certificate issued to me by NARM and want you to know that this certificate is given to anyone who has demonstrated
competency in their midwifery skills despite their chosen pathway to midwifery(PEP or MEAC). Our current law does_
not allow licensure for PEP trained midwives.
I also want to address the idea that was brought up by one individual who opposed this topic. Her issue was that the
"minimum education required to obtain a PEP is only a GED."That is the justthe minimum and a very classist idea if you
ask me. I myself completed a 4 year degree at BYU in marriage,family, and human development many years ago. I
decided on the PEP pathway because of its affordability and access for myself as a mother of five who is trying to put 2
of my kids through Punahou and supporting my husband as he completes a PhD at UH. There are others who have
chosen this route,and have had additional higher education experiences before choosing this profession.This certificate
issued to me and others required many many hours of training, studying, attending births and refining of skills. Let me
say this, in the case of an emergency my clients will not care whether I can write a term paper or not,they will care
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that I know how to respond and treat them and/or refer them to more advanced care which are all skills I fully
developed during my PEP study.Please do not let the minimum requirement to engage in a PEP program be a barrier
to passing this resolution...
Mahalo for taking the time to read this, and Mahalo for all you hard work you do for the people.
Sincerely,
A. Ezinne Dawson
Love is always the answer.
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