Midwives prepare for licensing

  • New mother Sierra Sugre nurses her baby while receiving care from midwife Nina Millar, during a postpartum visit at Island Mamas Midwifery in Hilo. (Courtesy photo/Dani Dougherty)

Midwives in Hawaii are gearing up for new licensing requirements that will go into effect this summer.

Under the new law, which was passed by legislators and signed by Gov. David Ige last year, anybody using the title of “midwife” must obtain a license starting July 1.


A handful of exemptions are in place, such as if an individual is currently a certified nurse-midwife already holding a valid license, a midwifery student enrolled in an educational midwifery program and under the supervision of a qualified instructor, or is rendering aid in an emergency.

An exception is also in place until July 1, 2023, for anyone acting as a birth attendant who does not administer drugs and who discloses their qualifications and lack of licensure.

Additionally, nothing in the law prohibits practices by traditional Hawaiian healers.

Le‘a Minton, board president of Midwives Alliance of Hawaii, said at this time, the organization doesn’t have specific concerns regarding the licensing process and implementation.

“Regulation of midwifery is needed in Hawaii for public safety,” Minton said in an email. “According to Hawaii state regulation laws, this is the reason to regulate a profession — for the benefit of the public and not for the specific benefit to the professional.

“We subscribe to this and strongly believe that regulating midwifery ensures that when a person says they are a midwife, the public can be assured that the person is in fact a midwife,” she continued. “It ensures that the midwife has met minimum education and training, and has demonstrated competency in a minimum set of skills. This is in alignment with all other health care professionals. The territory and state of Hawaii had a longer history of regulating midwifery than not. The last 21 years lacking regulation were due to an oversight.”

According to the legislation, Hawaii began regulating midwifery in 1931, starting with registration that progressed into certification then licensure.

Since 1998, however, there has been a lapse in the regulation of midwifery after nurse-midwives were placed under the purview of the state Board of Nursing.

Minton said licensure is appropriate because midwives are responsible for their clients’ lives, and licensure, which is the highest form of regulation, is recommended when the risk to a client can be high.

Regulation also provides a level of accountability and offers the public a means of recourse if they’re harmed.

“Without standards of care, accountability and a place of recourse, the public is vulnerable and can be harmed,” Minton said. “Previous to regulation anyone could say they were a midwife … Clients were not able to verify if the person was a midwife, what their education and training was, and/or if a midwife had come to Hawaii to practice after leaving another state due to a bad outcome or sanction on their license.”

Obtaining a license will require documentation proving an individuals to be a certified midwife or a certified professional midwife, the latter of which also would require proof of a successful completion of a formal midwifery education. Applicants would also need to submit any other midwifery licenses held in other jurisdictions and pay an application fee.

Licenses will have to be renewed every three years.

Although the new regulations will have more restrictions on the practice of “direct entry midwives,” Nina Millar, a certified professional midwife on the Big Island for 35 years, said it will ultimately allow for “that midwifery model of care to really start growing and catch up with midwifery as it is in most of the rest of the United States and around the world.”

She’s excited for the new law and said she’s been in favor of regulation.

“Now that it’s coming, I’m prepared to get the license and continue my practice and hopefully be able to expand it from what it is and make the midwifery model of care more accessible to more women.”

Millar said regulation will also allow certified midwives to have “greater access to collaborative care” with primary care physicians on the island — to order lab work, ultrasounds and medications — ultimately “providing better care to our clients versus what’s been happening to date.”

“I know it may be challenging for some people to change from their method of practice because we haven’t been regulated to this point, but in being licensed, I think it offers a greater ability to actually practice midwifery and provide a very needed service to our populous here … because we are so lacking in health care providers on the Big Island and (in the) state of Hawaii,” she said. “We can really fill a very vital role providing maternity care to our public here on the Big Island.”

As much as some may be opposed to the legislation, Millar said she thinks it will open up for doors for individuals “to have really good, quality care.”

Dani Dougherty, a certified professional midwife with Hilo-based Island Mamas Midwifery, works with Millar and shared similar sentiments.

“Personally, I think it’s been a long time coming,” said Dougherty, who has been a midwife in Hawaii for 10 years. “… I think it’s a positive step towards midwifery being recognized as a legitimate profession and a choice for maternity care providers for low-risk women who meet the criteria for home birth.”

Now individuals know that people who are advertising as a midwife have met the minimum competencies and standards for midwifery, she said.

“I really think that midwifery is important for future generations because it empowers women to make their own choices when it comes to how they want to birth,” Dougherty said. “It’s something I want to see live on and I think this is a way we can preserve the ancient art of midwifery in modern times.

The midwives both expressed concerns about the expected cost for the required license, which Millar said at a projected $3,000 “is extremely high.”

The legislation also calls for the appointment of an advisory committee to help with the implementation of the new regulations.

Dougherty said, too, that she is “waiting to see what the logistics will look like as the advisory board comes together to make decisions about rules and regulations.”

Email Stephanie Salmons at ssalmons@hawaiitribune-herald.com.

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