Ensuring the health, safety and welfare of citizens has always been a core value and responsibility of government in Hawaii. It’s why our state regulates and licenses professions and vocations across an array of industries, including construction, finance, insurance and many others. There’s little doubt, however, that the stakes are highest for state oversight within the health care industry, where lives are on the line.

In 2019, Hawaii took an important step forward in advancing health care safeguards for expectant mothers and newborn keiki with the passage of a law that established licensing and education requirements for midwives.

Midwives provide care to healthy birthing families, where most of the time the pregnancy remains low risk. As with all health professions, however, risk is inherent in maternity care as not all birthing people and newborns remain healthy and well. It is vital that midwives have the highest standard of education and training to identify when something is not normal, so they can inform birthing families of the need to be referred to an appropriate medical provider or facility to receive additional care.

Research published in 2022 regarding Hawaii births indicated that during the years prior to the midwife licensure law, babies who suffered brain injuries from lack of oxygen were almost three times more likely to have been a planned home birth compared to a planned hospital birth. Data from Oregon, which has a similar law, revealed unlicensed providers had a 400% higher rate of perinatal death compared to licensed midwives between 2012-2020.

Last week, state Rep. Linda Ichiyama noted that on more than one occasion, the Hawaii state auditor concluded the “services provided by a midwife to a mother and a newborn are such that full licensure is necessary.”

Hawaii has licensed 41 midwives, with 75% of those serving neighbor islands — nearly four times the number originally projected. So, if midwives are already licensed and data supports the importance of this law, why are we still discussing it in the Legislature? Unfortunately, a separate Hawaii law requires newly regulated professions to “sunset” after a certain number of years so the state can evaluate if the regulation should continue. In this case, the midwife licensure law is set to expire in June 2025 if legislators do not pass a bill, House Bill 1194, to maintain regulations for this important profession.

Despite the obvious need for safeguards, there have been misguided attempts to water down licensing requirements and misinterpretations of the bill. HB 1194 does not seek to regulate the support services that doulas, lactation consultants, Native Hawaiian healers and others may provide to birthing families. It ensures that birthing families can safely rely on the fact that anyone who calls themselves a midwife meets professional standards and is properly licensed.

Rep. Gregg Takayama, the House health committee chair, explained that the purpose of this legislation “is to enact professional standards of training, experience and knowledge for midwives, so that all expectant mothers can be assured of a safe quality of care when they utilize the services of a licensed midwife. Just as when they see a medical doctor or advanced practice nurse.”

Let’s protect birthing families and their keiki with the passage of HB 1194. Reports from the state Office of the Auditor, data on infant mortality and injuries, joyful stories of safe care under a midwife, as well as heart-breaking accounts from families who have suffered preventable tragedies during delivery make it clear that upholding the highest standards for licensure and education of midwives is in everyone’s best interest.

Dr. Michael Ching is immediate past president. American Academy of Pediatrics, Hawaii Chapter; Dr. Ricardo A. Molero Bravo is legislative chair, Hawaii section, American College of Obstetricians and Gynecologists; Leʻa Minton is board president, Midwives Alliance of Hawaii.