Maui County testifiers passionate over freedom to choose birth practitioner

Fervent testifiers over many hours at Maui County Council sought the freedom to choose birth practitioners regardless of licensure status.

Apprenticeship-trained midwives would be criminalized after July 1 — when the current exemption expires — if the state doesn’t approve pending legislation.

A resolution at Maui County Council on Friday urged state leaders to enact laws that would permanently exempt birth attendants from state licensure requirements, especially because the county’s rural areas have limited access to birth facilities and have historically relied on traditional midwives.

About 30 testifiers, most of whom are mothers who have had home births, spoke for hours to support the Maui County Council resolution to protect maternal autonomy.

“Look at how far we have to go to just be able to make a decision for our own self as a female person,” Scarlett Ritte of Molokaʻi testified at Friday’s council meeting. “Now we gotta go and do something else just to protect that right.”

The resolution highlights the importance of birth attendants for rural communities, especially those in Maui County. 

Maui resident Makalani Franco-Francis, who had traditional midwives for her three kids and is now an apprentice to traditional midwives, said traditional midwives fill the gaps of maternal health care in remote areas, including Hāna, Kīpahulu, Molokaʻi and Lānaʻi. 

“They need us to serve them and not be afraid of persecution,” she said at Friday’s council meeting.

Introduced by Council Member Keani Rawlins-Fernandez, whose residency seat covers Moloka’i, the resolution with a unanimous vote was adopted by council late Friday. Resolutions do not have the force and effect of law.

Maui County is disproportionately affected by state licensure requirements, Rawlins-Fernandez said before the vote. Maternal mortality outcomes are disproportionately high among Black, Filipino, Native Hawaiian and Pacific Islander birthing people.

“During testimony, one testifier asked herself out loud, ‘Why am I crying?’” Rawlins-Fernandez said before the vote. “I understand so deeply, there is so much trauma from being forced to participate in an oppressive system whether it’s being forced to birth in an unnatural setting or having to speak up in front of a government body to ask that our basic fundamental right to do what women have been doing since human life began is insulting and upsetting and emotional. I cried, too, today. How did we get to a place where indigenous and traditional birth attendants are at risk of being criminalized?”

Maui County’s resolution affirms state bills SB1047 / HB955. If approved, the state measures would permanently exempt birth attendants from being licensed and allow all Certified Professional Midwives to qualify for licensure.

There was overwhelming support for HB955 during a Friday state House Committee on Health and Homelessness hearing. The committee deferred decision-making until Wednesday.

The bill would make permanent the existing exemption for birth attendants to continue to practice without a license, under certain conditions. Also, it expands qualifications for licensure to include North American Registry of Midwives portfolio evaluation process.

Hawaiʻi’s existing midwifery licensure law (2019 Act 32, now codified as HRS 457-J) says that all midwives must be licensed after July 1, and in order to be licensed they must attend a school accredited by the Midwifery Education Accreditation Council (MEAC). 

However, there are no MEAC-accredited schools in Hawaiʻi, making the requirements for licensure prohibitively difficult for local midwives to obtain, according to a news release by state Rep. Natalia Hussey-Burdick, who helped draft HB955. 

Some midwives have been practicing under the temporary exemption for “birth attendants,” but they face an uncertain future at risk of criminalization, so they have already begun turning away clients despite high demand for their services, the release said.

Hawaiʻi’s 2019 law included a temporary exemption for people practicing as “birth attendants” but the exemption is scheduled to expire on July 1.