Frequently Asked Questions

The International Confederation of Midwives (ICM) defines:

"A midwife is a person who has successfully completed a midwifery education programme that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education and is recognized in the country where it is located; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery."

Midwives provide health care from menarche to menopause, offering care based on informed choice and collaborative decision making between provider and client. A midwife is an expert in normal, physiologic pregnancy, labor, birth, postpartum and normal newborn care. They are trained in essential competencies and incorporate the Midwives Model of Care™ in the services they provide within their communities.

There are three types of midwives who are nationally certified in the US. All of them have education and certification specifically in midwifery. CPMs and CMs are sometimes referred to as direct-entry midwives and they are licensed under the Hawaii Midwife Program. CNMs received a nursing education before they received midwifery education, and they are regulated under the Board of Nursing in Hawaii. 

CM/CNMs are at minimum trained at a master’s level education and are primary care providers with a scope of practice that extends from puberty through end of life, and newborn care. CM/CNMs education and training meets and exceeds the ICM standards for education and competencies.

CPMs can have a personal experience educational route (experienced midwife), apprenticeship educational pathway (PEP process), or an accredited education (MEAC) that may result in a certificate, diploma, bachelors or masters in midwifery. To align with ICM standards for education, US MERA recommends all CPMs certified on or after January 1, 2020 have a MEAC accredited education.

Learn more about nationally certified midwives below:

Direct-Entry Midwives
A direct-entry midwife completed their education through a midwife program/pathway  and has been nationally certified in midwifery. 

• Certified Professional Midwife (CPM): A certified professional midwife has gained certification through examination from the North American Registry of Midwives (NARM). NARM defines a CPM as:

  "a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care.”

The CPM credential requires knowledge about and experience in community settings.

• Certified Midwife (CM): A certified midwife is a direct-entry midwife who has gained certification through examination from the American Midwifery Certification Board (ACMB). The American College of Nurse-Midwives (ACNM), the professional organization for CMs and CNMs, defines a CM as:

  "individuals who have or receive a background in a health related field other than nursing and graduate from a midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME).” 

CMs take the same national certification examination as CNMs but receive the professional designation of certified midwife.

Certified Nurse-Midwives 

• CNM: Certified Nurse-Midwives are certified by the AMCB, the same body that certifies CMs. ACNM, the professional organization of CMs and CNMs, defines a CNM as:

  "registered nurses who have graduated from a nurse-midwifery education program accredited by the ACME and have passed a national certification examination to receive the professional designation of certified nurse-midwife. Nurse-midwives have been practicing in the U.S. since the 1920s."

Certified-nurse midwives are licensed as advanced practice registered nurses in the State of Hawaii.

CM/CNMs full scope practice includes primary care of women from puberty through end of life, well-woman care (including cervical cancer and breast cancer screenings), gynecological care and gynecological issues, family planning and STI/STD screening and treatment for women and men, pregnancy care and newborn care. CM/CNMs scope includes prescriptive authority as they have graduate level pharmacological education and training. Their scope does include prescribing Schedule II - IV legend drugs, obtaining a DEA license, and having a medication-assisted treatment (MAT) waiver for treating opioid addiction. CMs/CNMs also have a process for adding additional training and scope of practice to their skill set beyond their basic midwifery training. With additional training, CMs/CNMs can provide 1st assistant services for cesarean surgeries, perform vacuum-assisted deliveries and provide gynecological and obstetrical ultrasound services.

Hawaii’s licensure laws allow CNMs to practice autonomously to their fullest scope, while it currently limits CMs scope of practice. 

CPMs scope of practice includes well-woman care (including cervical cancer and breast cancer screenings), family planning counseling and dispensing of non-hormonal contraceptive methods, STI/STD screening, pregnancy care and newborn care. CPMs do not have scope for prescriptive authority; they are trained in administering medications used in pregnancy, postpartum and newborn care. 

A licensed midwife has demonstrated to the State of Hawaii that they have met the education and competency requirements to practice midwifery. A licensed midwife abides by all State laws and adheres to an international standard of midwifery care. 

Licensed midwives provide prenatal and postpartum services inclusive of ordering and interpreting lab tests, administering medications as needed, and collaborating with and/or referring to other health care providers. Additionally, a MAH Registry midwife can file your birth certificate from the convenience of your home.

Yes. On April 30, 2019 Governor David Ige signed midwifery licensure into law. Midwives (Certified Professional Midwives and Certified Midwives), Advanced Practice Registered Nurses (APRNs including Certified Nurse-Midwives and Nurse Practitioners), Physicians (OBGYNs and Family Medicine), Physician Assistants, and Naturopaths are all required to be licensed to practice and provide services to the public. These providers, if obstetrics was part of their education and training, are able to provide prenatal, birth and postpartum care. 

Through June 30, 2023 a person who is not licensed to practice in Hawaii and is providing maternity care, may be exempt from licensure if they inform you of the items required in Hawaii Revised Statute Chapter 457J and sign a disclosure form with you.

You can check here to find out if your provider is licensed to practice in Hawaii, and if you are planning a home birth you can also check if your midwife’s name is on our MAH Registry. All midwives listed on the MAH Registry are licensed to practice in Hawaii.  

Families continue to maintain their right to choose how, where and with whom they birth because licensure regulates professionals, not the location that they provide services.

We recommend you speak with your insurance company to find out what coverage they offer. Each insurance plan within each state is distinct. If you have a flex spending plan, health savings account, or faith based cost sharing plan, check with your plan about utilizing your account for payment of midwifery services.

Currently, all insurance companies recognize APRNs for reimbursement. If you are seeing a CNM, check with them if they take your insurance. For care received by CPMs or CMs, check with your insurance if your provider is in-network and/or if your insurance reimburses for out-of-network providers. At this time, Hawaii MedQUEST recognizes CNMs but not CMs or CPMs for reimbursement of midwifery care.

The birth center is a healthcare facility for childbirth where care is provided in the midwifery and wellness model. The birth center is freestanding and not a hospital.

There are no birth centers in Hawaii at this time. Previously there was a birth center in Wahiawa on Oahu. Maternity hospitals often refer to their labor, delivery, recovery and postpartum facilities as “family birth centers'', but they are not in accordance with the American Association of Birth Centers.

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General questions

1. What type of midwife are you certified as?
2. Is your midwifery license in Hawaii current and have you been licensed elsewhere?
3. Are there special limitations imposed on your license in Hawaii?
4. What professional liability insurance do you carry, if any?
5. What professional peer review process do you participate in?
6. Are you an in-network provider with any insurance plans?
7. What is your experience and how long have you practiced?
8. What other providers are part of your practice or do you collaborate with?
9. What professional midwife organizations are you affiliated with? 

Planned home birth questions

1. Can you describe what your practice looks like for my birth and where appointments will take place? 
2. How many people do you plan to have at my birth? What are their roles and experience? 
3. Do you have any doulas you would recommend? 
4. Do you offer additional services such as water birth or childbirth/newborn care/lactation classes? 
5. What time frame are you available on-call for my home delivery? (ex: from 37-42 weeks)
6. What does your plan look like for my care if for some reason you’re unavailable?
7. What is your protocol if I go beyond 41 weeks? 
8. Do you require me to have co-care with an OB?
9. What do you define as a high-risk condition in pregnancy or postpartum and at what point would it no longer be safe for me to be under your care?
10. Do you consistently offer informed choice on all levels of your care? 
11. What tests or screens do you require for me to receive your care?
12. What is the availability and access for treatment under your care for the following:
    1. Lab work including for anemia, Rh neg factors, STI/STDs, and GBS
    2. Vitals including high blood pressure
    3. Screening for genetic abnormalities
    4. Gestational diabetes screen
    5. Ultrasound and Doppler use
    6. Uterine abnormalities/ unique anatomy
    7. My baby not being head down for birth
    8. Group Beta Strep (GBS) infection
    9. Pain management
    10. Management of labor and birth complications
    11. Perineal tears and treatment
    12. Transfer of care to a hospital
    13. Vitamin K/Antibiotic eye ointment/Hep B vaccine for newborns
    14. Failure to thrive/ low weight gain in newborns  
    15. Identifying and supporting nursing difficulties, tongue and/or lip-ties & structural abnormalities
13. What is your postpartum schedule for me and my baby/babies under your care?
14. Do you help me file for a birth certificate and Social security card?
15. Is lactation support included in my care and do you have additional specialized training in it? 
16. Do you provide midwifery care if I plan to deliver in a hospital with another provider?
17. Do you provide midwifery care if I plan to have an unassisted birth?

Financial consideration questions

1. What is included in your cost of care? Do you itemize or is it a global fee? 
2. Will the cost of my labs and ultrasounds be covered under your fee?
3. Is my birth kit included or do I buy it separate? 
4. If I want a birth tub, do you have a resource for rental or purchase of a tub?
5. What is your payment plan and when is the balance due for my care?
6. Do you have a refund policy if risk out of a homebirth or if I end my care by choice? 

MAH supports the profession of midwifery through:

1. Advocacy at state and local levels, such as with midwifery licensure;
2. Their liaison role to the Department of Health in filing birth certificates and providing newborn metabolic and hearing screenings of infants born at home;
3. Connecting and networking with persons interested in entering the profession of midwifery;
4. Promoting opportunities for professional continuing education, including supporting maintenance and education of midwifery standards by offering peer review for special circumstances;
5. Collaboration and participation with the Hawaii Maternal and Infant Health Collaborative, Hawaii Women’s Coalition and the Hawaii Maternal Mortality Review Committee;
6. Providing resources for professionals to learn about midwifery in Hawaii; and
7. Providing education and information for consumers to access licensed midwives.  

If you are interested in becoming a midwife, or are a midwife looking for educational opportunities or resources, we encourage you to check out our Professional Resources page.

To learn more about safety in pregnancy regarding COVID-19, please visit the CDC website.  

For up to date information regarding COVID-19 vaccine safety in pregnancy and breastfeeding, you can check the CDC guidelines. 

If you’re interested in reading studies on COVID-19 vaccines safety in pregnant women, click here. 

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