ABOUT US >

Midwives Alliance of Hawaii (MAH) was founded as a domestic non-profit organization in May 1993 and was re-birthed in August 2011. We are currently working on becoming a 501(c)3 federally recognized non-profit.

 

MAH is pleased to work with all who are interested in midwifery as a standard of care for women and babies.

 

MAH provides families access to safe, quality midwives who believe that pregnancy and childbirth are healthy natural processes. 

 

Please join us as we work to further the art and profession of midwifery.

CONTACT >

P.O. Box 241

Hau'ula, HI 96717

E: midwiveshawaii@gmail.com

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Frequently Asked Questions

MAH welcomes feedback and questions. Have a question? Email us at midwiveshawaii@gmail.com

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Clarifications about Midwifery
What is the International Confederation of Midwives (ICM)?

ICM is an accredited non-governmental organization representing midwives and midwifery to organizations worldwide to achieve common goals in the care of mothers and newborns. ICM works closely with the WHO, UNFPA and other UN Agencies; global professional health care organisations including the International Federation of Gynecology and Obstetrics (FIGO), the International Pediatric Association (IPA), the International Council of Nurses (ICN), non-governmental organisations; bilateral and civil society groups. There are 132 ICM Member Associations  in 113 Countries across 6 regions of the world, representing over 500,000 midwives.

Why are the ICM definitions of midwife, midwifery, scope of practice and essential competencies important?

There is a need to help the consumer understand the landscape of healthcare options regarding well women care, pregnancy, birth and newborn care.  There is an imperative for definitions and consistency. There are specific definitions for all healthcare professionals. These definitions are governed by multi stakeholder groups that, by consensus, determine specific aptitudes and criteria for upholding the competencies of that profession. Within the practice of midwifery, the ICM represents that governance committee, and is the organization responsible for upholding the international definitions of midwife, midwifery scope of practice, and essential competencies. This ensures that the average consumer -- expecting parents -- can trust that any midwife that represents as such has met a universally recognized standard for the midwifery profession.

What is US MERA?

US MERA formed in the US to determine how to implement the ICM definitions and standards for midwifery. US MERA is a coalition comprised of representatives of national midwifery associations, certifying bodies and education accreditation agencies including: Accreditation Commission for Midwifery Education (ACME) , American Midwifery Certification Board (AMCB), American College of Nurse-Midwives (ACNM), North American Registry of Midwives (NARM), Midwifery Education Accreditation Council (MEAC), National Association of CPMs (NACPM), Midwives Alliance of North America (MANA); and the International Center for Traditional Childbearing.

Through a consensus process US MERA produced two documents based on the ICM definitions and standards. These two documents were utilized in recommending language for SB1033: model legislation and regulatory language regarding certified professional midwives.

US MERA’s vision is an integrative US healthcare system where everyone has access to midwives and midwifery care that improves health. Their mission is to bring together leadership and expertise to identify priorities and to be a unified, credible, recognized voice for issues that affect midwifery education, certification, accreditation, regulation, association and practice. The goal is to increase access to high quality and culturally relevant midwifery care.

What is a midwife?

​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."

When we use the term midwife, we are always using the ICM definition.

What does a midwife do?

Midwives provide women's health care from menarche to menopause, offering a client centered model of care based in informed choice and consensual decision making between provider and client. A midwife is an expert in normal, physiologic pregnancy, labor, birth, postpartum and normal newborn care. 

Click here to read about the 5 things the United Nations wants you to know about midwives.

Midwives incorporate the Midwives Model of Care™ within the services they provide to their community.

"The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events.

 

The Midwives Model of Care includes:

  • Monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle

  • Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support

  • Minimizing technological interventions and;

  • Identifying and referring women who require obstetrical attention

​​

The application of this woman centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section."

Copyright © 1996-2008, Midwifery Task Force, Inc., All Rights Reserved.

What are the different types of midwives in the United States and Hawai'i?

​There are 3 types of midwives who are nationally certified in the US. All three types have training specifically in midwifery. 2 of the 3 types of midwives, CPMs and CMs, are called direct-entry midwives because they went to midwifery school. Direct-entry midwives are not regulated in Hawaiʻi. The 3rd type of midwife, CNM, received a nursing education before they received midwifery education; their path was not directly into midwifery. CNMs are regulated under the Board of Nursing in Hawaiʻi. The 3 types of midwives who are nationally certified are:

  • Certified Professional Midwife (CPM): A certified professional midwife has gained certification in direct-entry midwifery from the North American Registry of Midwives (NARM). A direct-entry midwife completed midwifery education and has been nationally certified in midwifery. NARM defines a CPM:

"A Certified Professional Midwife (CPM) is 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 is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings."

"Certified midwives are 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). Graduates of an ACME accredited midwifery education program take the same national certification examination as CNMs but receive the professional designation of certified midwife."

  • Certified Nurse-Midwife (CNM): A certified nurse-midwife has completed a graduate degree and received midwifery certification from ACMB (the same body that grants the CM credential). They also hold a registered nurse license. ACNM, also the professional organization for CNMs, defines a CNM:

"Certified nurse-midwives are registered nurses who have graduated from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME) (formerly the American College of Nurse-Midwives (ACNM) Division of Accreditation (DOA)) 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 Hawai'i. Direct-entry midwives are not regulated.

What is the certifying body, educational accrediting agency and national organization for certified professional midwives (CPMs)?

The certifying body is The North American Registry of Midwives (NARM). NARM  supports a health care system where every family in North America has access to skilled and responsible midwives.

The CPM certification, issued by NARM, is accredited by the National Commission for Certifying Agencies (NCCA), which is the same agency that accredits the Certified Nurse-Midwife and Certified Midwife certification.  The CPM is the only NCCA-accredited midwifery certification that includes a requirement for out-of-hospital experience.

 

The educational accrediting agency is the Midwifery Education Accreditation Council (MEAC). MEAC is an independent, nonprofit organization recognized by the U.S. Department of Education

as an accrediting agency of direct-entry midwifery institutions and programs. MEAC creates standards and criteria for the education of midwives, which incorporate the nationally recognized core competencies and guiding principles set by Midwives Alliance of North America (MANA), The International Confederation of Midwives (ICM),  and the requirements for national certification of the North American Registry of Midwives (NARM).  

The National Association of Certified Professional Midwives (NACPM) is the national professional organization for CPMs. NACPM envisions a primary birth care system in our country where all birthing people access care through a midwife, where birth place is the choice of the family, and where all childbearing people and their babies have the same chance to be healthy. NACPM’s purpose is to be a powerful, collective voice for CPMs, strengthening and supporting excellence in the profession and influencing birth health policy to ensure that all childbearing people and babies have a healthy start. NACPM provides core documents to their members.

 

What is the certifying body, educational accrediting agency and national organization for certified midwives and certified nurse-midwives (CMs/CNMs)?

The certifying body is the American Midwifery Certification Board (AMCB). AMCB’s mission is to protect and serve the public by leading the certification standards in midwifery. Their vision is to advance the health and wellbeing of women and newborns by setting the standard for midwifery excellence. They develop and administer the certification exam for assessment of entry-level competencies for the practice of midwifery, and maintain professional discipline for all CM/CNMs. The CM/CNM certification, issued by AMCB, is accredited by the National Commission for Certifying Agencies (NCCA), which is the same agency that accredits the CPM certification.

 

The educational accrediting agency is the Accreditation Commission for Midwifery Education (ACME). ACME’s mission is to advance excellence in midwifery education and is a recognized  programmatic accrediting agency for midwifery programs by the U.S. Department of Education.

 

The American College of Nurse-Midwives (ACNM) is the national professional organization for CM/CNMs. ACNM is the oldest women's health care organization in the United States. It’s core values include: excellence, evidence-based care, formal education, inclusiveness, woman-centered care and respect for the physiologic process, and primary care. ACNM is committed to upholding the highest clinical and ethical standards, professional responsibility, accountability, and integrity; strongly support the use of quality measurement to improve care; support interprofessional education of midwives with other health professionals to improve maternity care and women's health services; promotes a culture of inclusion in which diverse identities are respected, sought, and embraced, and all can contribute to their full potentials and rise to leadership roles; respects each woman's right to dominion over her own health and care; promotes and preserves normal birth; and emphasize health promotion and education, disease prevention, and informed decision-making.

 

What is the difference between a CM and CNM?

A Certified Midwife (CM) and a Certified Nurse-Midwife (CNM) fulfill the same role in the health field as they have the same graduate education and same scope of practice. The primary place of practice for both is a clinic, hospital or birth center.  Both CNMs and CMs also attend community based births, and currently there are 3 CNMs attending community births in Hawaiʻi. The difference between the titles is that CMs have a bachelor's level education in a health related field before entering into midwifery school whereas CNMs have training in both nursing and midwifery. Both CMs and CNMs complete masters level education, attend the same classes and complete the same curriculum in graduate midwifery school.  CMs and CNMs take the exact same certification exam through AMCB. For further information you can refer to ACNM’s website.

You can watch a short 2 minute animated video: What is a CM? 

 

What is the difference between a CM/CNM and CPM?

The main differences between CM/CNM and CPMs is that:

  • 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. Some of the educational pathways (experienced midwife and PEP) do not meet the ICM standards for education; this is why US MERA language recommends all CPMs certified on or after January 1, 2020 have a MEAC accredited education.  

 

CERTIFIED MIDWIFE (CM) and CERTIFIED NURSE-MIDWIFE (CNM):

  • Minimum degree required for certification: Graduate Degree

  • Minimum education requirements for Admission to Midwifery Education Program: Bachelor’s Degree or higher from an accredited college or university.

CERTIFIED PROFESSIONAL MIDWIFE (CPM):

  • Minimum degree required for certification: Certification does not require an academic degree, but is based on demonstrated competency in specified areas of knowledge and skills.

  • Minimum education requirements: High School Diploma or equivalent.

You can view a comparison chart between CNM, CM and CPM here

 

What is the difference in scope between a CM/CNM and CPM?

CM/CNMs full scope practice includes primary care of women from puberty through end of life, well-woman care (including pap smears and breast exams), 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.

 

CPMs scope of practice includes well-woman care (including pap smears and breast exams), 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 and many states provide authority for CPMs to obtain, carry and administer these medications.

Click here to read about the 5 things the United Nations wants you to know about midwives, their scope of practice and impact on women and children's health. 

 
SB1033: Legislative Questions:
What does SB1033 SD2 HD2 do?

SB1033 SD2 HD2 recognizes the profession of midwifery, states it is mandatory to have a license to practice midwifery in Hawaiʻi, lists the requirements for licensure and provides some permanent and some temporary exemptions to certain categories of persons, including birth attendants. Native Hawaiian healers are protected under the State Constitution so this bill does not apply to Native Hawaiian healing practices as midwifery is defined separately.

 

What does SB1033 SD2 HD2 mean? I thought this bill was SB1033.

SB1033 SD2 HD2 means that the original bill, SB1033 went through two Senate drafts and two House drafts. SD stands for Senate Draft and HD stands for House Draft. That means that SB1033 was amended in each committee it was heard in. The current version of the bill that all the legislators in the House and Senate have voted on is what was sent to the Governor to sign.

 

Is SB1033 SD2 HD2 a law?  

Yes! As of 4/30/2019 SB1033 became law as Act 32 when it was signed into law by Governor Ige. SB1033 SD2 HD2 passed it’s Third Reading in the House of Representatives on 4/9/19 and was sent through cross over to the Senate. The Senate voted on Thursday 4/11/19 that they agreed to the amendments from the House, meaning they accepted SB1033 SD2 HD2 in it’s current form. The vote on 4/11 was for the Senate to decide if they agreed or disagreed with the House amendments. When the Senate agreed to accept the House amendments, the Senate provided a required 24-hour notice for an official Senate vote on whether to pass SB1033 SD2 HD2 out of the Senate. The vote was held on Friday 4/12/19 and the Senate voted to pass SB1033 SD2 HD2 with 19 ayes and 2 noes and 4 excused. SB1033 SD2 HD2 was enrolled to the Governor to be signed into law, and he signed it on 4/30/2019!

 

Was SB1033 S2 HD2 ‘fast-tracked’ through legislation?

No. SB1033 SD2 HD2 went through all of its assigned committee hearings and decision makings, as well as floor votes in both the Senate and House. You can follow through all of the hearings and decisions notated on the measure status page, as well as read testimony and committee reports, view hearing notices and see the multiple versions of the bill.

 

Anyone wishing to have greater understanding of the information provided on the status measure online can contact the Hawaii Public Access Room 808-587-0478.

 

What is the legislative process that SB1033 SD2 HD2 is following?

A Citizen’s Guide to Participation in the Legislative Process explains the process and on page 1 shows a diagram of how a bill becomes law in the Hawaiʻi State Legislature. 

  
SB1033: Clarifications about the Bill
Where are the administration rules for SB1033 SD2 HD2?

The administrative rules for SB1033 SD2 HD2 are separate from the licensing statute. They will be developed by the Department of Commerce and Consumer Affairs now that SB1033 SD2 HD2 has become law.

 

Why are CNMs not included in this bill and is their practice affected by SB1033 SD2 HD2?

CNMs are not included in this bill because they are already regulated and licensed under the Board of Nursing. SB1033 SD2 HD2 will not affect their ability to practice. SB1033 SD2 HD2 is for midwives who are not currently regulated in Hawai’i.

 

Does this bill end the PEP process as an educational pathway in Hawaiʻi?

Yes. The PEP process is not an accredited educational pathway and does not meet ICM educational standards. In accordance with US MERA language, persons who become certified as a CPM on or after January 1, 2020 will be required to have a MEAC accredited education in order to obtain licensure in Hawaiʻi.

 

SB1033 SD2 HD2 recognizes and provides eligibility of licensure for people who received their CPM through the PEP process prior to January 1, 2020. In accordance with US MERA language, SB1033 SD2 HD2 requires CPMs certified through the PEP process prior to January 1, 2020 to obtain a Midwifery Bridge Certificate from NARM. The Midwifery Bridge Certificate requires 50 accredited continuing education hours within the five-year period prior to application. The continuing education hours, predominantly available online, must be in maternal, newborn and relevant topic categories, with at least one hands-on course in both maternal and newborn categories. The Midwifery Bridge Certificate is a one-time certificate. It does not require any extra recertification outside of the CPM requirement.

 

What are the educational pathways available in HI to become a midwife now that SB1033 SD2 HD2 is law? And is financial aid available?

There are 3 types of midwives in the US: certified professional midwives (CPMs) certified midwives (CMs), and certified nurse-midwives (CNMs).

  • All three pathways have educational options through online programs if persons do not wish to move to another state and attend a brick-and-mortar school. CPMs would go through a MEAC accredited program; 6 out of the 11 schools accept Title IV financial aid. CM/CNMs would go through an ACME accredited program; all schools accept Title IV financial aid.

  • There are currently midwife preceptors on Kauaʻi, Oʻahu, Maui, Molokaʻi, and Hawaiʻi islands.

  • There are currently student midwives for both CPM (MEAC accredited) and CNM ( ACME accredited) programs living and studying in Hawaiʻi. Currently there are no student CMs in HI. Now that SB1033 SD2 HD2 is law, we expect student midwives will also choose to become a CM (ACME accredited programs).

  • With SB1033 SD2 HD2 becoming law, Hawaiʻi is more likely to consider having a midwifery school in state. Hawaiʻi needed recognition of the profession for the opportunity to discuss the opening of a midwifery school.

 

Who in HI supports SB1033 SD2 HD2?

SB1033 SD2 HD2 is supported by a wide range of individuals representing the diversity of Hawaiʻi.

 

We have supportive written testimony from American College of Obstetricians and Gynecologists Hawaiʻi Chapter, American Academy of Pediatrics Hawaiʻi, Hawaii Pacific Health (Kapiolani, Wilcox, Straub and Pali Momi), NARM, Hawaii Women's Coalition, Hawaii Maternal Infant Health Collaborative, Early Childhood Action Strategy, Hawaiʻi Children’s Action Network, American Association of University Women, Breastfeeding Hawaiʻi, individual neonatologists, obstetricians, midwives, nurses, other health care professionals, clients, and community members.

 

Will SB1033 SD2 HD2 make persons illegal after 2023?

No.

  • SB1033 SD2 HD2 regulates midwifery and midwives. It does not make any persons illegal prior to or after 2023.

  • SB1033 SD2 HD2 does state that effective July 1, 2023 persons practicing midwifery are required to have a license to practice. Meaning, as of July 1, 2023 fines can be levied against someone practicing midwifery without a license; this is in accordance with other regulated professions. This does not mean a person is made illegal.

  • Persons providing birth services are exempt through July 1, 2023 from needing a license to practice midwifery. Legislators requested they use the next three years to define themselves, their scope, and the pathway that is acceptable to them to be recognized. Their work will be received by legislators and per the SB1033 SD2 HD2 preamble, legislators intend to enact statutes to allow birth practitioners to practice to the fullest extent under the law.

 
Aren't all health professionals required to be licensed in Hawai'i?

​Yes. However, that licensure is missing for direct-entry midwives. Two sunrise analyses in 1999 and 2017 by the State Auditor report that midwifery meets the criteria for being a regulated profession, that it should be regulated in its entirety.

 

Currently, Ob/Gyns, NDs and CNMs are all licensed prenatal, labor and birth and postpartum care providers. CNMs are the only midwives licensed in Hawai'i.

 

CPMs and CMs are not licensed or regulated. Other kinds of traditional birth attendants are not licensed or regulated by the state.

 

What are the benefits of midwifery licensure?

Some of the benefits of midwifery licensure and regulation include:

  • Recognizing midwifery as a profession, which can increase the number of persons choosing it as a profession 

  • Expanding healthcare access to women and families, especially in rural and remote areas of Hawaiʻi 

  • Decreasing maternity provider shortages 

  • Increasing a network of collaborative care providers, servicing at-need populations and increasing utilization of telehealth 

  • Expanding women’s options for maternity providers

  • Potentially reducing infant morbidity and mortality rates through integration of midwifery into health care system  

  • Providing consumers with complaint process addressing midwifery care providers

  • Increasing accountability of midwives to consumers, the health care system and within the profession  

  • Potentially increasing educational opportunities locally for midwifery studies, thereby potentially increasing diversity in the profession of midwifery  

  • Reducing providers practicing without oversight who have had their licenses revoked, suspended or otherwise penalized in other state

  • Potentially allowing midwives to accept insurance, thereby increasing access to high-quality care for families

  • Facilitating smoother transfers of care from midwife to higher level care providers (such as hospitals and/or Ob/Gyn) when necessary, creating better outcomes for families. Read more about the Best Practice Transfer Guidelines by clicking here: Best Practice Transfer Guidelines 

For families, this means that they will have better access to care and more choice in safe providers. It means that they will know their chosen provider has had a minimum standard of education. Licensure ensures that families have protection if their midwife/birth attendant is practicing unsafely. It also ensures that midwives and providers who have lost their licenses in other states will not be able to continue to practice here in Hawai'i without the Department of Commerce and Consumer Affairs reviewing their application for licensure and determining if they can legally practice in Hawaiʻi.

 

This article, "Midwifery linked to better birth outcomes in state-by-state report card", is a good overview of the research showing that integrating midwives into the broader maternity care system can improve outcomes for families. Licensure provides a better integration of direct-entry midwives into the health care system in the state of Hawai'i.

How will licensure increase access to midwifery care, and community-based birth (including home birth)?
  • Regulation and licensure of midwifery expands access to care by integrating midwives into the healthcare system so that all families can access midwives should they choose.

  • Midwives are independent providers who collaborate with healthcare professionals, practice in all settings and support families choice of where they intend to birth.

  • The majority of unregulated midwives in Hawaiʻi live and work on neighbor islands and rural communities; licensing them would increase maternity care providers across the state.

  • Families continue to maintain their right to choose how and where they birth and with whom because midwifery regulation is not restrictive of practice location. Licensure regulates the profession of midwifery, not the location of midwifery services or where a family chooses to give birth. 

  • Regulation ensures midwives have met minimum competencies and standards of practice before providing healthcare services to families, and provides professional accountability through access to a complaint process if a midwife is practicing unsafely. This increases safety and access for all families.

 
History
When did the effort to license midwives in Hawai'i start? 

Midwives historically were regulated in Hawai'i. It was only recently (in 1998) that direct-entry midwives became unregulated. What follows is a time line of regulation of midwives in the state, and efforts at regulation after 1998:

  • 1931: Territorial Board of Health in Hawaiʻi registered midwives 

  • 1941: Act 87 regulated midwifery under the Territorial Board of Health. Midwifery statute said persons cannot practice midwifery without a license.

  • 1998: Recommendation for certified nurse midwives (CNMs) to be under Board of Nursing (BON). Certified professional midwives (CPMs) proposed licensure (HB3123). Legislators recommend sunrise analysis (SCR64). 

  • 1999: CNMs moved under BON; DOH midwifery statute repealed. BON says one cannot practice nursing without a license; Hawaiʻi no longer had regulation of the midwifery profession.

  • 1999: State Auditor Sunrise Analysis recommends regulation of midwifery profession. No legislation enacted.

  • 2014: Bill introduced to regulate home birth (SB2569)

  • 2016: Bill introduced to regulate CPMs (HB1899); state auditor sunrise analysis requested by legislators (HCR65).

  • 2017: State Auditor Sunrise Analysis (17-01) recommends regulation of midwifery profession including certified midwives (CMs). Midwife licensure bill introduced (SB1312). 

  • 2018: Bill introduced to regulate CPMs and CMs (HB2184).

  • 2019: Bill introduced to regulate CPMs and CMs (SB1033).

  • 2019: Governor Ige signs SB1033 into law as Act 32 effectively regulating midwifery in Hawaiʻi. 

What is the history of midwifery in the United States?

Midwives and traditional birth attendants have a long and rich history in the US. Before colonization, native birth practices were strong and families were always attended by these skilled healers during their births. During colonization, midwives from many other countries traveled to the US to attend the deliveries of colonists. The colonists and plantation owners also brought midwives as slaves from West Africa to attend to both the births of the slaves and the plantation families alike in the antebellum south. These black midwives were called “granny midwives” and continued to serve both black and white families in the south well into the 1950s.

 

These midwives and traditional birth attendants cared for families, and the majority of births took place in the home in the US until the early 20th century. The rise of physicians and physician led care began in the early 1900’s, and by this time midwives attended about half of all births in the US. This number dwindled to less than 20% by 1935 and use of midwives continued to decline.

 

The National Association of Certified Professional Midwives (NACPM) writes:

“Midwives continued to practice in certain populations that actively chose to maintain their traditions of midwifery for religious or cultural reasons and in those communities that were denied access to medical institutions and physician care because of segregation laws. In some instances, the midwives were exempted from restrictive laws and in others they were careful not to reveal their practice. Anti-immigration laws reduced the number of new immigrant midwives and the assimilation of second and third generation women further contributed to the decline of midwifery. In the case of Japanese-American midwives, internment during the Second World War virtually ended their service. African-American and Hispanic midwives served their ethnic communities and some white women well into mid-century. In 1950, while midwives attended less than 5% of all births in the U.S., they still attended one-fourth of all non-white births.

 

By 1975, the number of midwife-attended births reached its lowest point at less than 1% of births overall and 2.4% of non-white births. The few remaining traditional midwives were being forcibly retired and the legacy of race, gender and class injustice surrounding midwifery was deeply embedded in the dominant American cultural beliefs about birth and midwifery.”

 

However, during the 1920’s nurse-midwifery began and started to gain momentum. Nurse-midwives gained recognition and continued to attend home births and births in rural areas through the 1950s. By the 1970s, the majority of births were happening in the hospital, and nurse-midwives moved from a primarily community-based practice to a primarily hospital based model. At this time there were around 1000 nurse-midwives practicing in the US, and national standards for education and certification had been established. They have since gained recognition in all 50 states in the US, primarily work in hospital and clinic based settings, and in 2013 attended about 8.3% of all births in the US. Learn more about nurse-midwives at midwife.org.

 

During the rise of nurse-midwifery, other kinds of midwives and birth attendants were being marginalized and oppressed. Many granny midwives were forced out of their practices and criminalized through institutionalized racism. Japanese-immigrant midwives were all but eliminated during the internment camps during World War II. Other kinds of birth attendants were also often pushed out during efforts to regulate and license maternity care providers.

 

In the 1970s, there was a small birth revolution among middle-class white women that led to them using midwives and having more home births. This group of women often used ‘lay’ midwives, or informally trained midwives, to attend their births. This brought attention to home birth and direct-entry (non-nurse) midwifery in the US. From this movement, the certified professional midwife credential grew.

 
MAH History
What is the history of Midwives Alliance of Hawai'i (MAH)?

Midwives Alliance of Hawaii (MAH) was founded as a domestic non-profit organization in May 1993 and was re-birthed in August 2011.

What is the purpose of MAH?

The purpose of MAH is to preserve the art, science and the independent practice of midwifery while promoting good public relations through education with the people of Hawaiʻi. MAH does this by:

 

  1. Promoting the intrinsic right of women to give birth as they choose.

  2. Promoting midwifery as a standard of health care for women and babies.

  3. Supporting and protecting the independent practice of midwifery.

  4. Supporting the training and practice of midwives according to national standards.

  5. Increasing public awareness about midwifery care in Hawai’i.

  6. Educating policy makers and stakeholders about the profession of midwifery.

  7. Facilitating the education and professional accountability of practicing midwives through peer review and data collection.

  8. Promoting collaboration between midwives and other professionals.

Has MAH always supported licensure?

MAH has advocated for midwifery licensure since 1998 in an effort to improve access to midwifery care, ensure standards and competencies of the midwifery profession are met, provide a level of safety in care, and ensure the community has access to a complaint process.

Does MAH work with other organizations?

Our collaborative efforts include participating as a member of the Hawaii Maternal and Infant Health Collaborative; Women's Coalition; Maternal Mortality Review Committee; Screening, Brief Intervention, Referral and Treatment committee; Hawaii Children's Action Network; and developing a Community Birth Transfer form with input from a multidisciplinary team.