HomeMy WebLinkAboutCOM 0104.007 2022-2024 P/aoA c
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Hawaii Homebirth Collective
1188 Bishop Street Suite 1509
Honolulu,HI 96813 W n
-71
Testimony of the Hawaii Home Birth Task Force Chair ^
And Board President of the Hawaii Home Birth Collective <
Before Big Island Ciy Council Members _ ;
Tuesday February 20,2023 9:00 a.m. _. "
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Aloha Chair Cindy Evans and Council Members:
My name is Kristie Duarte and I was the Chair of the Hawaii Home Birth Task Force created by Act 32
(2019). I am also the Board President of the Hawaii Home Birth Collective (HIHBC), an organization dedicated
to the preservation, perpetuation, and diversity of home birth practices and autonomy in home birth midwifery
care.
As the Chair of the Hawaii Home Birth Task Force, I want to stress how important this 2023 session is.
On July 1,2023, birth attendants with different cultural skills and practices will become illegal unless we pass
new legislation this year.Act 32 (2019) stated"By the end of the three year period,the legislature intends to
enact statutes that will incorporate all birth practitioners and allow them to practice to the fullest extent under
the law."
We continue to offer full support of Resolution 57-23 which seeks to match Oregon's State law and
other states that allow permanent exemptions for traditional & cultural practices. We would also like to offer
additional comments to clarify some misconceptions that have been brought up in previous testimony and
questions from legislators:
Point#1: According to the DCCA website, there are currently 28 Licensed Midwives throughout the
islands, but many are not currently practicing or taking clients,and NONE have obtained their licensure
through the required MEAC accredited school pathway without leaving Hawaii to complete their
training. Others have moved here from the Mainland to complete their training, but none of these have
fully trained in Hawaii while attending a MEAC accredited school.
• Out of the 28 Midwives licensed under HRS § 457J:
o Only 14 Licensed Midwives are currently practicing and accepting clients throughout the
islands.
Comm. No 'JAI
Ref. To:•
Ref. Date_ FEB 2 1 2023
O 0 have obtained their license through the MEAC school while being fully trained in Hawaii.
All local MEAC-pathway CPMs have had to travel to other states in order to attend enough
births to qualify-even the ones who took courses online.
o 15 moved to Hawaii with their certification already obtained. This highlights the clear
educational disadvantage for local midwives. Hawaii's current licensure requirements inherently
favor midwives trained on the continent who haven't attended any births here in Hawaii, and may
be unfamiliar with the different needs and healthcare facilities that may or may not be available
in different areas of different islands.
o 0 are Kanaka Maoli.
Point#2: On July 1,2023, birth attendants with different cultural skills and practices will become illegal
unless we pass new legislation this year.
• They will be punished with the following penalties:
[§457J-13/ Penalties. Any person who violates this chapter or rules adopted pursuant
thereto shall be subject to a fine of not more than$1,000 for each separate offense. For purposes
of this section, each day of violation shall constitute a separate offense. [L 2019, c 32,pt of§2]
Point#3: The 3 year exemption period for Birth Attendants in Act 32 (2019)was not a "grace period to
allow them time to become certified" - their practice of traditional midwifery is recognized in the Sunrise
Analysis Reports of 1999 and 2017 as a different type of practitioner whose skills are valued and
sometimes preferred.
• Act 32 (2019) stated"By the end of the three year period, the legislature intends to enact statutes that
will incorporate all birth practitioners and allow them to practice to the fullest extent under the law."
• Act 32 (,2019)never intended for these birth practitioners to obtain licensure, but rather intended for the
Legislature to convene a task force and pass legislation based on their recommendations. SB2428
(2020), SB893 (2021), and SB2661 (2022)were different suggestions recommended by the task force,
but the legislature didn't pass those, so we have now arrived at the simplest, least controversial
recommendations for r1B955 / SB 1047: 1)allow birth attendants to continue to practice under the same
conditions they have been since 2019; and 2) allow all Certified Professional Midwives(CPMs)to
qualify for licensure, not just the ones who have attended MEAC-accredited schools on the continent.
• Birth attendants have different traditional,cultural,and/or religious values and practices than
CPMs.To require them to obtain a Western education in addition to their traditional training and
education is not what the various Sunrise Reports recommended.
Point#4: Traditionally- trained birth attendants of all cultures are valued, preferred, and it should be the
birthing person's choice.
• There was unanimous agreement with all 12 members of the 2019 Home Birth Task Force Report
that:
o Traditional midwives currently exist in Hawaii,they define themselves as Traditional
midwives and are in demand by the communities they serve.
o Traditional midwives are recognized and defined by Midwives Alliance of North America,
and states such as Oregon and Canada formally recognize and perpetuate their practices
by creating pathways other than licensure to allow Traditional midwives to continue to
serve their communities.
o Each woman has a right to choose where and with whom she gives birth
• The 2/8/2023 Committee Report from the House Health&Human Services Committee stated:
"Your Committee finds that traditionally-trained birth attendants of all cultures are
valued and preferred by some consumers, and that the type of birth attendant utilized at a birth
should be the birthing person's choice. "
• The Maui County Council unanimously passed Resolution 23-28 on 2/3/23 URGING THE
LEGISLATURE TO ENACT A STATUTE PERMANENTLY EXEMPTING BIRTH ATTENDANTS
FROM STATE LICENSURE REQUIREMENTS.
Point#5: It was NOT an oversight of the legislature in 1998 that midwifery became unregulated when the
CNM-midwifery law was repealed with the passage of HB2855 (Act 279). There was another bill going
through the legislature at the same time proposing licensure of CPMs. That bill was deferred in order to
complete a Sunrise Analysis by the Auditor, which concluded in the 1999 Sunrise Report, that"regulation
would be premature until key issues are resolved."
• Both Sunrise Analysis Reports of 1999 and 2017 acknowledged Traditional Midwives as a
legitimate segment of the midwifery profession in Hawai'i.
o The 1999 Sunrise Analysis was concerned about fragmented regulation and a lack of agreement
about qualifications and practice standards for lay midwifery-due to there being so many
different types (Certified Professional, Certified,Lay, Direct-entry,traditional or empirical,pg. 2,
13)
o Included on the last page of the 1999 Report was a response from the Department of Health
stating"there should be a distinction" in regulation between the different types of midwives.
o The 2017 Sunrise Analysis recommended that licensure NOT benefit only one segment of the
midwifery profession and that licensure should actually encompass ALL practicing
midwives-recommending the legislature examine other standards for traditional midwives
outside of requiring a certification from a private midwifery association-because to require
certification would create an unnecessary and unfair competitive advantage for CPMs.
• Act 32 (20191 created a task force to propose legislation that would incorporate all birth practitioners,
to be able to regulate the entire profession of midwifery, and not just segments of it to avoid an
unnecessary and unfair competitive advantage.
Point#6: HB 955 fulfills the requirements of The Hawai'i Regulatory Licensing Reform Act, HRS §
Chapter 26H.
• The Hawaii Regulatory Licensing Reform Act states:
"Regulation in the form of full licensure or other restrictions on certain professions or
vocations shall be retained or adopted when the health, safety, or welfare of the consumer may be
jeopardized by the nature of the service offered by the provider".
• Regulation of the birth attendant through use of"other restrictions"other than licensure is found in the
requirements set forth in HRS 457J (6)-5,which outlines informed consent disclosure forms and very
specific conditions under which the birth attendants are allowed to practice. HB 955 HD1 continues to
resolve this key issue through regulation of the birth attendant through the restrictions set forth in
this exemption.
• This does not mean licensure is voluntary. It means that midwives are regulated through licensure, and
birth attendants are regulated through other restrictions. These restrictions on birth attendants have
allowed the community to still have access to culturally appropriate care and still be able to make
informed decisions about their reproductive rights. Ultimately,the health, safety and welfare of the
consumer is protected through the regulations set forth in HRS 457J(6)-5.
Point#7: The Hawaii Regulatory Licensing Reform Act.HRS § Chapter 26H,states that"regulation
must not unreasonably restrict entry into professions and vocations by all qualified persons".
• Hawaii's midwifery law currently leaves out a nationally recognized pathway to certification
which would allow for more local midwives to obtain licensure through an approved educational
route of entry provided by the North American Registry of Midwives (NARM)through the Portfolio
Evaluation Process (PEP).
• People certified through this educational evaluation process(PEP) have completed a rigorous approved
educational route and attended at least 55 births under the supervision of a registered preceptor,
demonstrated clinical skills,and passed the same exam that is required for certification of those who
attend a MEAC accredited school.
• For opponents to say a MEAC education is"the same cost as UH"really reflects an inability to
understand our communities. Many of Hawaii's families and students, especially from lower income
rural communities, are priced out of higher education of any kind. It costs so much more than the
standard$15-50 k for tuition: for HIHBC's licensed midwives, it has costs thousands in travel &
lodging over the years,they needed to pay their preceptor for their time(which was difficult for them to
even find one to work with, having even to pay for a preceptor to move here), and they needed someone
to financially support them with rent/utilities/food etc because it's hard for student midwives to
maintain any type of employment while they're always on-call for births that could happen at any time.
• Although a few of the MEAC accredited colleges are available online,this does not make it accessible
for those who do not have steady online access (like our rural areas)and for those who are not
financially supported, as described above. Requiring only the MEAC accredited pathway for CPMs is
causing a disproportionate hardship for people who live in Hawaii, especially women of color and
people who live in underserved communities. The Portfolio Evaluation Process is included in HB 955
HD 1 as a pathway to obtain the same certification as a MEAC accredited pathway, resulting in
qualification for licensure.
Point#8: Oregon State has an exemption which regulates their Traditional Midwives,similar to the birth
attendant exemption in HB 955 HD 1.
• Birth Attendant is defined the same way as it is in Oregon State- by similar restrictions they must
follow to practice;
• Birth attendants/Midwives who have lost their license elsewhere are required when they move to
Hawaii to disclose to their client in the Required Disclosure Form provided by the DCCA, both verbally
and in written form creating safe guards for all working as a birth attendant:
"any information/documentation of any judgment, award, disciplinary sanction, order, or
other determination that adjudges or finds that he/she committed misconduct or was
criminally or civilly liable for conduct relating to midwifery by a licensing or regulatory
authority, territory, state, or any other jurisdiction".
For those reasons,we are respectfully requesting Big Island Council Members pass Resolution 57-23.
Respectfully,
Kristie Duarte, President
Hawaii Homebirth Collective