S.B. NO.














relating to midwives.





SECTION 1. Section 457J-2, Hawaii Revised Statutes, is amended as follows:

1. By adding four new definitions to be appropriately inserted and to read:

""Direct-entry midwife" means an independent practitioner educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school, college, or university-based program distinct from the discipline of nursing and who is trained to provide the midwives model of care to healthy women and newborns throughout the childbearing cycle, primarily in out-of-hospital settings.

"Licensed midwife" means a person licensed under this chapter.

"Midwifery model of care" means monitoring the physical, psychological, and social well-being of a birthing parent throughout the childbearing cycle; providing them with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support; minimizing technological interventions; and referring birthing persons who require obstetrical attention.

"Traditional midwife" means an autonomous midwife who has acquired the skills to care for pregnant people, babies, and their families throughout pregnancy, birth, and postpartum through a spiritual or cultural lineage, is recognized nationally and internationally by the Midwifery Education Accreditation Commission and Midwifery Alliance of North America, and does not advertise as a certified or licensed midwife."

2. By amending the definition of "qualified midwife preceptor" to read:

""Qualified midwife preceptor" means [a] an exempt or licensed and experienced midwife, or other maternal health professional licensed in the State, who participates in the clinical education of [individuals enrolled in a midwifery education program accredited by the Midwifery Education Accreditation Council or Accreditation Commission For Midwifery Education and who meets the criteria for midwife preceptors set forth by the applicable organization.] midwives."

3. By deleting the definition of "midwife":

[""Midwife" means a person licensed under this chapter."]

SECTION 2. Section 457J-3, Hawaii Revised Statutes, is amended to read as follows:

"[[]457J-3[]] [Midwives] Midwife licensing program. There is established a [midwives] midwife licensing program within the department to be administered by the director.

SECTION 3. Section 457J-4, Hawaii Revised Statutes, is amended to read as follows:

"[[]457J-4[]] Powers and duties of the director. In addition to any other powers and duties authorized by law, the director shall have the power and duties to:

(1) Grant permission to a person to use the title of ["midwife" or] "licensed midwife" and engage in the practice of midwifery in this State pursuant to this chapter and the rules adopted pursuant thereto;

(2) Adopt, amend, or repeal rules pursuant to chapter 91 to carry out the purposes of this chapter;

(3) Administer, coordinate, and enforce this chapter and rules adopted pursuant thereto;

(4) Discipline a licensee for any cause described by this chapter or for any violation of rules or refuse to license a person for failure to meet the licensing requirements or for any cause that would be grounds for disciplining a licensee;

(5) Appoint an advisory committee to assist with the implementation of this chapter and the rules adopted pursuant thereto. The advisory committee shall consist of the following:

(A) Three midwives who are certified professional [midwives or certified] midwives;

(B) Two members of the public; and

(C) A certified [nurse] midwife[;], if available; and

(6) Add, remove, or otherwise modify the authorized non-controlled legend drugs and legend devices listed in 457J-11 by rule under chapter 91."

SECTION 4. Section 457J-5, Hawaii Revised Statutes, is amended to read as follows:

"[[]457J-5[]] License required. (a) Beginning July 1, 2020, except as provided in this chapter, no person shall [engage in the practice of midwifery, or] use the title ["midwife",] "licensed midwife"[,] or the abbreviation "L.M.", or any other words, letters, abbreviations, or insignia indicating or implying that the person is a licensed midwife without a valid license issued pursuant to this chapter.

(b) Nothing in this section shall preclude a person holding a national certification as a midwife from identifying the person as holding such certification, so long as the person is not [practicing midwifery or] professing to be [authorized to practice midwifery in the State] a licensed midwife unless that person is licensed in accordance with this chapter."

SECTION 5. Section 457J-6, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:

"(a) A person may practice midwifery without a license to practice midwifery if the person is:

(1) A certified nurse-midwife holding a valid license under chapter 457;

(2) Licensed and performing work within the scope of practice or duties of the person's profession that overlaps with the practice of midwifery;

(3) A student midwife who is currently enrolled in a midwifery educational program under the direct supervision of a qualified midwife preceptor;

(4) A person rendering aid in an emergency where no fee for the service is contemplated, charged, or received; or

(5) A person acting as a [birth attendant on or before July 1, 2023,] direct-entry midwife, who:

(A) Does not use legend drugs or devices, the use of which requires a license under the laws of the State[;], with the exception of oxygen and a department of commerce and consumer affairs approved anti-hemorrhagic agent;

(B) Does not advertise that the person is a licensed midwife;

(C) Discloses to each client verbally and in writing on a form adopted by the department, which shall be received and executed by the person under the [birth attendant's] direct-entry midwife's care at the time care is first initiated:

(i) That the person does not possess a professional license issued by the State to provide health or maternity care to women or infants;

(ii) That the person's education and qualifications have not been reviewed by the State;

(iii) The person's education and training;

(iv) That the person is not authorized to acquire, carry, administer, or direct others to administer legend drugs;

(v) Any judgment, award, disciplinary sanction, order, or other determination that adjudges or finds that the person has committed misconduct or is criminally or civilly liable for conduct relating to midwifery by a licensing or regulatory authority, territory, state, or any other jurisdiction; and

(vi) A plan for transporting the client to the nearest hospital if a problem arises during the client's care; and

(D) Maintains a copy of the form required by subparagraph (C) for at least ten years and makes the form available for inspection upon request by the department.

(b) Nothing in this chapter shall prohibit healing practices by [traditional]:

(1) Traditional Hawaiian healers engaged in traditional healing practices of prenatal, maternal, and child care as recognized by any council of kupuna convened by Papa Ola Lokahi[.]; or

(2) Traditional midwives as defined in section 457J-2.

Nothing in this chapter shall limit, alter, or otherwise adversely impact the practice of traditional Native Hawaiian healing pursuant to the Constitution of the State of Hawaii."

SECTION 6. Section 457J-8, Hawaii Revised Statutes, is amended by amending the title to read as follows:

"[[]457J-8[]] Application for license as a licensed midwife."

SECTION 7. Section 457J-11, Hawaii Revised Statutes, is amended as follows:

1. By amending subsection (a) to read:

"(a) A licensed midwife licensed under this chapter may purchase and administer non-controlled legend drugs and devices that are used in pregnancy, birth, postpartum care, newborn care, or resuscitation, and that are deemed integral to providing care to the public by the department."

2. By amending subsection (d) to read:

"(d) A pharmacist who dispenses drugs and devices to a licensed midwife as authorized by this section and in conformity with chapter 461 is not liable for any adverse reactions caused by the licensed midwife's administration of legend drugs and devices."

SECTION 8. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 9. This Act shall take effect upon its approval.








Report Title:

Midwives; Licensure; Direct-entry Midwives; Traditional Midwives; Exemption



Amends various provisions related to the licensure of midwives. Allows direct-entry midwives to practice midwifery under certain conditions.




The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.