SB274 revises Hawaii’s midwifery licensing framework by replacing the expiring chapter 457J sunset structure with a new, ongoing licensing program for certified midwives and certified professional midwives administered by the Department of Commerce and Consumer Affairs. The bill defines the two license categories, sets education, certification, age, and background requirements, and creates an advisory committee that includes midwives, public members, a traditional birth attendant, and Native Hawaiian practitioners. It also sets renewal, discipline, fee, reporting, and enforcement provisions, and requires annual reporting to the Legislature on licensure, complaints, and related issues.
The bill substantially expands the scope of practice for licensed midwives. It authorizes licensed midwives to provide care in hospitals, clinics, birth centers, community settings, and homes; order and interpret tests; perform ultrasounds; provide assessments and counseling; and, for certified midwives and certified professional midwives, obtain limited prescriptive authority under specified conditions. It also requires health plans and Medicaid to cover covered midwifery services regardless of location, and it prohibits unlicensed use of protected titles while preserving exemptions for certified nurse-midwives, students, family care, doulas, emergency aid, cultural and religious birth practices, and traditional birth attendants who meet disclosure and safety requirements. The bill also re-establishes a temporary home birth task force to study home birth coordination, safety, transport, education, and data issues, with a report due in 2026.
The bill’s stated policy goal is to preserve licensure for nationally certified midwives while broadening legal access for community and traditional birth practices, especially in light of Hawaii’s maternal care shortages and the Legislature’s findings about cultural access, safety, and local training pathways. It reflects a generally supportive posture toward midwifery and home-birth access, emphasizing consumer choice, culturally responsive care, and the need to reduce barriers for Hawaii residents seeking licensure. The bill text and accompanying description indicate an intent to maintain and formalize the profession rather than eliminate regulation.
The main points of contention appear to center on how far state regulation should extend, particularly regarding traditional birth attendants, cultural practitioners, and non-clinical family or community support roles. The bill tries to balance licensure with exemptions and explicit protections for Native Hawaiian practices, ethnic cultural practices, prayer-based care, doulas, lactation support, and family-assisted births, while still imposing disclosure requirements on traditional birth attendants who are not licensed. Another likely area of debate is the expansion of prescriptive authority and the breadth of the licensed midwife scope of practice, including care in non-hospital settings and insurance coverage mandates. No committee transcript or recorded votes were provided, so the overall sentiment can only be inferred from the bill’s findings and structure, which are strongly favorable to expanding lawful midwifery access while preserving targeted regulation.
SB274 would repeal the current sunset date for chapter 457J and replace it with a new statutory framework governing licensed certified midwives and licensed certified professional midwives. It would amend Hawaii law to create licensing, discipline, fee, renewal, reporting, and enforcement provisions under the Department of Commerce and Consumer Affairs, while also establishing a new home birth task force under the Department of Health. The bill would affect health care licensing law, insurance coverage requirements, Medicaid reimbursement, and the legal status of midwifery-related titles and practices, while expressly preserving certain traditional, cultural, religious, family, and student-related birth practices outside the licensing regime.
The bill’s overall sentiment appears favorable to midwifery access, home birth, and culturally responsive maternal care. Its findings emphasize safety, access shortages, Native Hawaiian and community-based practices, and the need for local pathways into licensure, suggesting strong policy support for the bill’s core approach. Because no committee testimony or vote record was provided, there is no direct evidence of opposition or amendment activity in the available materials.
The most notable contention is the tension between professional licensure and the bill’s effort to preserve traditional and cultural birth practices without overregulation. Supporters of broader access would likely favor the bill’s exemptions, task force, and expanded scope of practice, while critics may question whether the bill goes too far in allowing non-hospital practice, limited prescriptive authority, and insurance coverage mandates. Another likely point of debate is whether the bill adequately protects patient safety while also avoiding barriers for traditional birth attendants and Native Hawaiian practitioners, especially given the disclosure requirements and the distinction between licensed and unlicensed providers.