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Lobbying continues for midwifery licensing bill at state Capitol

midwife demonstration hawaii state capitoljpg
Savannah Harriman-Pote
Bonny Colunga attends the Birth Freedom Rally at the Hawaiʻi State Capitol on March 6, 2023. Colunga, who is not directly affiliated with any of the groups, said she supports the bill because she supports women's choice.

A bill to define licensure laws for traditional birth attendants died in the state House of Representatives last week, but some members of the public haven’t given up hope.

About two dozen people held a sit-in at the state Capitol last week lobbying for House Bill 955 to be heard, and many are expected to attend another rally this week.

Traditional birth attendant Kiʻi Kahoʻohanohano flew to Oʻahu from Maui looking for answers last week.

midwife demonstration hawaii state capitol.jpg
Savannah Harriman-Pote
Sovereign Duarte stands amongst others at the Birth Freedom Rally on March 6, 2023. Supporters gather to back House Bill 955, nicknamed Sovereign’s Law, after it failed to move forward in the Legislature.

"We just want to be seen, and, you know, they didn't respond," Kahoʻohanohano said Friday. "I feel like the tension just started to grow as other community members who were concerned also started to show up."

The peaceful sit-in began in the office Rep. Kyle Yamashita of Maui, who holds the influential position of House finance chair (he did not respond to HPR’s requests for comment). Scheduling of the bill came down to Yamashita's committee.

Some constituents are trying to have the bill waived through the Finance Committee and heard on the floor instead, since it does not have any fiscal impacts.

HB955 builds off of work from Act 32 in 2019, which gave the state until June 30 of this year to determine licensing standards for birth attendants.

The proposal this year would allow traditional birth attendants (different than certified licensed midwives who already have specific licensing requirements) to use the Portfolio Evaluation Process, known as PEP, to qualify for status. Currently, licensing is through attendance of a Midwifery Education Accreditation Council-accredited school.

By the end of June, traditional birth attendants will be barred from practicing if the bill does not pass this session.

Rep. Natalia Hussey-Burdick of Oʻahu introduced the bill, she said this bill is different than others in that killing the bill without discussion will result in near-immediate effects.

"This isn't just like any other bill where they can just try again next year, many highly qualified birth practitioners are scheduled to become illegal in four months, so they've already been turning away patients and women are giving birth in cars on the side of the road because they live too far away from a hospital and there aren't enough licensed midwives in our area," Hussey-Burdick said last week.

Certified professional midwife Dani Dougherty in Hilo said she thinks adding the Portfolio Evaluation Process, or PEP, as a means of licensing isn’t the best move.

"I just think that there, the discussion is still greatly needed before we just make a revision that says, the PEP process is enough to be a midwife here," Dougherty said.

Dougherty comes from a family of midwives. She originally went through the PEP process, but found herself going back to a MEAC school for more training.

"The PEP process is a hands-on apprenticeship where you have a qualified preceptor who is observing you, and checking off your skills and allowing for you to get that experience under her covering," she said.

birth freedom rally hawaii state capitol midwives.jpg
Savannah Harriman-Pote
Birth Freedom Rally organizers gathered in the Hawaiʻi State Capitol rotunda on March 6, 2023 to urge the passage of House Bill 955.

"I deep down knew that while I was giving information to women that worked, it was sometimes information I had meant memorized and was regurgitating, but didn't have a working understanding, or knowledge of the human body in a way that I could truly understand what I was even saying," Dougherty said.

With her licensing now, there's deeper understanding, she said.

"I went back to school and got a bachelor's degree in pre-med, because I specifically wanted to take anatomy and physiology, pathophysiology, microbiology, nutrition, I really wanted to understand why I was giving the advice I was giving," Dougherty said.

Where HB955 stands now, it may be too late to ensure those traditional birth attendants throughout the islands will be able to continue practicing.

"So our perspective is more about learning by doing hands-on apprenticeship in the way of our kūpuna, which has been passed on for generations, which, unfortunately because of regulation, and criminalization and persecution of our kūpuna healers, in general, throughout history we're very limited," Kahoʻohanohano said.

Kahoʻohanohano said between 2019 and now, lawmakers originally intended to figure out licensing or determine if traditional birth attendants would be exempt.

Dougherty said in a perfect world a bill would require licensure but also pay homage to what has culturally been passed down.

"I think that that's just a really important piece of preserving traditional midwifery is marrying those two worlds so there's not such a big divide between Western medicine and traditional midwifery," she said.

Sabrina Bodon is Hawaiʻi Public Radio's government reporter. Contact her at sbodon@hawaiipublicradio.org or 808-792-8252.
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