S.B. NO.














relating to licensure of certified professional midwives.





     SECTION 1.  The legislature finds that the Hawaiian Islands have a culture and traditional heritage that includes midwifery care.  Mothers have accessed midwifery care throughout history regardless of their religious, economic, or personal reasons.  As determined by Senate Concurrent Resolution No. 64, S.D.1 (1998), and a subsequent sunrise audit report, Auditor's Report No. 99-14 (1999), the legislature finds that it is necessary to establish a regulatory process for certified professional midwives.

     The purpose of this Act is to regulate the practice of midwifery care by establishing licensure requirements, continuing education requirements, and minimum training standards.

     SECTION 2.  The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:


certified professional midwives

     §   -1  Definitions.  As used in this chapter:

     "Certified professional midwife" means a person who is certified by the North American Registry of Midwives or any successor organization.

     "Client" means a person under the care of a licensed midwife, as well as the person's fetus and newborn child.

     "Department" means the department of commerce and consumer affairs.

     "Director" means the director of commerce and consumer affairs.

     "Licensed midwife" means an individual who holds a current license issued by the department pursuant to this chapter to engage in the practice of midwifery in Hawaii.

     "Midwifery Education Accreditation Council" means the organization established in 1991 and recognized by the United States Department of Education as an accrediting agency for midwifery education programs and institutions.

     "Midwives Alliance of North America" means a professional organization representing out-of-hospital birth midwives.

     "National Association of Certified Professional Midwives" means the membership organization that specifically represents certified professional midwives in the United States.

     "North American Registry of Midwives" means the organization that sets standards for competency based certification for certified professional midwives.

     "Out-of-hospital" means taking place in a birth center or home.

     "Postpartum period" means the period not exceeding six weeks from the date of delivery.

     "Practice of midwifery" means providing well-woman and maternity care for individuals and their newborns during the antepartum, intrapartum, and postpartum periods.

     "Traditional birth attendant" or "traditional midwife" means a person who assists a mother during childbirth and who initially acquired the person's skills by delivering babies, through an apprenticeship to other traditional birth attendants, or through cultural lineage and who practices independently and does not hold formal certification.

     "United States Midwifery Education, Regulation, and Association" means a coalition comprised of representatives of the following national midwifery associations, credentialing bodies, and education accreditation bodies: Accreditation Commission for Midwifery Education, American College of Nurse Midwives, American Midwifery Certification Board, Midwifery Education Accreditation Council, Midwives Alliance of North America, National Association of Certified Professional Midwives, and North American Registry of Midwives.  

     §  -2  Powers and duties.  In addition to any other powers and duties authorized by law, the director shall:

     (1)  Receive applications for licensure;

     (2)  Determine the qualifications of persons applying for licensure;

     (3)  Grant licenses to qualified applicants;

     (4)  Establish procedures to renew, suspend, revoke, and reinstate licenses;

     (5)  Establish and collect fees for the examination of applicants for licensure and license renewal;

     (6)  Establish the minimum educational and continuing educational requirements for licensure;

     (7)  Investigate complaints against licensed midwives;

     (8)  Undertake, when appropriate, disciplinary hearings; and

     (9)  Subject to chapter 91, adopt, amend, or repeal rules, as necessary to effectuate this chapter.

     §  -3  Advisory committee; appointment; term.  (a)  The director shall appoint an advisory committee to serve as experts to the department in licensing matters.  The advisory committee shall consist of eight members as follows:

     (1)  The director or the director's designee, who shall be a non-voting member;

     (2)  Four licensed midwives who shall be in current and active practice in the State for the duration of their appointment and who shall have actively practiced as licensed midwives in the State for at least three years immediately preceding their appointment, who shall be voting members; provided that the initial members appointed pursuant to this paragraph shall be three certified professional midwives and one certified nurse midwife who each have at least three years of experience in the practice of midwifery and who are eligible to become licensed pursuant to this chapter;

     (3)  One traditional birth attendant, who shall be a voting member;

     (4)  One licensed physician, who has provided primary maternity care for at least twenty births in the twelve-month period prior to appointment, maintains current hospital privileges, and has attended at least one home birth, who shall be a non-voting member; and

     (5)  One out-of-hospital birth consumer, who is either currently under midwifery care and planning an out-of-hospital birth or has had an out-of hospital-birth in the past, who shall be a non-voting member.

     (b)  Members of the committee shall serve four year terms.

     (c)  In the event of the death, resignation, or removal of any committee member before the expiration of the member's term, the vacancy shall be filled for the unexpired portion of the term in the same manner as the original appointment.

     (d)  The committee shall elect a chairperson from amongst its members.  The committee shall meet at least annually to make recommendations to the director and may hold additional meetings at the call of the chairperson or at the written request of any two members of the committee.  Three voting members shall constitute a quorum.  The vote of the majority of members present at a meeting in which a quorum is present shall determine the action of the committee.

     §  -4  Scope of practice; formulary.  (a)  The director shall establish scope of practice standards for the practice of midwifery.

     (b)  The scope of practice standards shall include:

     (1)  Adoption of a drug formulary recommended by the advisory committee and approved by the director; and

     (2)  Practice standards for antepartum, intrapartum, postpartum, and newborn care that prohibit a licensed midwife from providing care for a client with a history of disorders, diagnoses, conditions, or symptoms outside of the scope of practice recommended by the advisory committee and approved by the director pursuant to the standards of the National Association of Certified Professional Midwives.

     (c)  The scope of practice standards:

     (1)  Shall not require a licensed midwife to practice under the supervision of another health care provider, except as a condition imposed as a result of discipline by the department;

     (2)  Shall not require a licensed midwife to enter into an agreement with another health care provider, except as a condition imposed as a result of discipline by the department;

     (3)  Shall not impose distance or time restrictions on where a licensed midwife may practice;

     (4)  Shall not grant a licensed midwife prescriptive privileges outside of the privilege of ordering, obtaining, and administering medications on the approved formulary; and

     (5)  Shall not allow a licensed midwife to perform abortions.

     §  -5  License; qualifications.  (a)  A license to practice midwifery pursuant to this chapter shall be granted to an applicant who files a department-approved application for licensure, pays the required application fees, and provides evidence to the department of the following:

     (1)  Current certification as a certified professional midwife by the North American Registry of Midwives or a successor organization;

     (2)  Completion of an educational program or pathway accredited by the Midwifery Education Accreditation Council or having obtained the midwifery bridge certificate issued by North American Registry of Midwives;

     (3)  Documentation of a graduate letter from a Midwifery Education Accreditation Council accredited school or letter of completion of portfolio evaluation process; and

     (4)  Successful completion of continuing education requirements.

     (b)  All licenses issued under this chapter shall be valid for two years from the date of issuance.

     §  -6  Fees; penalties.  (a)  Each applicant shall pay a licensing fee of $250 upon application for a new or renewal license.  Fees collected pursuant to this section shall be deposited into the compliance resolution fund established pursuant to section 26-9(o).

     (b)  Any fine imposed by the department after a hearing conducted pursuant to this chapter shall be no less than $100 and no more than $1,000 for the first violation.  A second or subsequent violation of this chapter shall be referred to the office of the attorney general for criminal prosecution.  Any person who pleads guilty to or is found guilty of a second or subsequent violation of this chapter shall be guilty of a misdemeanor.

     §  -7  Hearings.  (a)  Unless otherwise provided by law, in every case in which the department refuses to issue, renew, restore, or reinstate a license under this chapter, or proposes to take disciplinary action or other licensing sanctions against a licensee, the department shall conduct an administrative proceeding in accordance with chapter 91.

     (b)  In all proceedings before it, the department and each member thereof shall have the same powers respecting administering oaths, compelling the attendance of witnesses and the production of documentary evidence, and examining witnesses as are possessed by circuit courts.  In case of disobedience by any person of any order of the department or of a member thereof, or of any subpoena issued by it or a member, or the refusal of any witness to testify to any matter regarding which the witness may be questioned lawfully, any circuit judge, on application by the department or a member thereof, shall compel obedience as in the case of disobedience of the requirements of a subpoena issued by a circuit court, or a refusal to testify therein.

     §  -8  Exemptions.  This chapter shall not apply to the following:

     (1)  Certified nurse midwives authorized by the board of nursing to practice in Hawaii, unless the certified nurse midwife chooses to become concurrently licensed under this chapter.  Certified nurse midwives with concurrent licensure shall be subject to chapter 457, as well as this chapter;

     (2)  Student midwives in training under the direct supervision of licensed midwives as required by North American Registry of Midwives;

     (3)  A person administering care to a spouse or parent;

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

     (5)  A traditional birth attendant who does not receive compensation for midwifery services; or

     (6)  Other than as provided in paragraph (1), the practice of a profession by persons who are licensed, certified, or registered under other laws of this State and are performing services within their authorized scope of practice.

     §  -9  Client protection.  A licensed midwife shall not:

     (1)  Disregard a client's dignity or right to privacy as to the client's person, condition, possessions, or medical record;

     (2)  Breach any legal requirement of confidentiality with respect to a client, unless ordered by a court of law;

     (3)  Submit a birth certificate known by the licensed midwife to be false or fraudulent, or willfully make or file false or incomplete reports or records in the practice of midwifery;

     (4)  Fail to provide information sufficient to allow a client to give fully informed consent;

     (5)  Engage in the practice of midwifery while impaired because of the use of alcoholic beverages or drugs; or

     (6)  Violate any other standards of conduct as determined by the department.

     §  -10  Disclosure; record keeping.  (a)  Before initiating care, a licensed midwife shall obtain a signed informed consent agreement from each client, acknowledging receipt, at minimum, of the current North American Registry of Midwives required Informed Disclosure for Midwifery Care.

     (b)  All licensed midwives shall maintain a record of signed informed consent agreements for each client pursuant to section 622-58.

     §  -11  Immunity from vicarious liability.  No licensed medical provider or facility providing medical care or treatment to a person due to an emergency arising during childbirth as a consequence of care received by a licensed midwife shall be held liable for any civil damages as a result of such medical care or treatment unless the damages result from the licensed medical provider or facility's provision of or failure to provide medical care or treatment under circumstances demonstrating a reckless disregard for the consequences so as to affect the life or health of another.  A physician who consults with a licensed midwife but who does not examine or treat a client of the midwife shall not be deemed to have created a physician-patient relationship with the client."

     SECTION 3.  If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of the Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable.

     SECTION 4.  This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

     SECTION 5.  This Act shall take effect upon its approval; provided that section 2 of this Act shall take effect on July 1, 2017.








Report Title:

Licensure; Midwife



Establishes licensure requirements for the practice of midwifery.  Requires the Director of Commerce and Consumer Affairs to adopt rules regulating the practice of midwifery.




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