HB2184 & SB2294 FAQs
HB2184/SB2294 Relating to Licensure of Midwives FAQs
1. Is this a home birth bill?
No. This bill licenses the profession of midwifery and does not regulate home birth.
2. What are the different types of midwives and who would be licensed?
There are 3 types midwives who are nationally certified. They are certified nurse-midwives (CNM), certified midwives (CM) and certified professional midwives (CPM). CNMs are already licensed in Hawaii under the Board of Nursing; this bill does not affect CNMs. CMs and CPMs would be licensed under HB2184/SB2294.
3. How are CMs and CPMs different from CNMs?
CMs and CNMs both have advanced degrees in midwifery and they have the exact same scope of practice as midwives, but CMs do not have a degree in nursing or a registered nurse license. CMs are not nurses and they do not qualify to be Advanced Practice Registered Nurses so they cannot obtain a license in Hawaii at this time.
CMs and CPMs have a similar scope of practice and two definite differences. CPMs do not have prescriptive authority and they cannot assist with surgeries.
4. Are traditional Native Hawaiian healing practices protected in HB2184/SB2294?
The Office of Hawaiian Affairs provided recommended language in their testimony last year that guarantees traditional Hawaiian healing practices are not prohibited. The language in HB2184/SB2294 comes from their recommendations.
5. Does the bill protect or exempt “traditional midwives”, especially those who are not practicing Hawaiian traditions?
No, this bill does not exempt “traditional midwives”.
Some birth workers in the community have identified with Midwives Alliance of North America’s (MANA) definition: “There are midwives who—for religious, personal, and philosophical reasons—choose not to become certified or licensed. Typically they are called traditional midwives. They believe that they are ultimately accountable to the communities they serve; or that midwifery is a social contract between the midwife and client/patient, and should not be legislated at all; or that women have a right to choose qualified care providers regardless of their legal status.”
Those who identify as “traditional midwives” have been and are continually encouraged to provide to legislators the language they wish to see to protect their practices.
6. What is the definition of a midwife?
The International Confederation of Midwives (ICM) definition of a midwife is:
"A midwife is a person who has successfully completed a midwifery education programme that is duly recognized in the country where it is located and that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education; 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.
The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.
A midwife may practice in any setting including the home, community, hospitals, clinics or health units."
7. Will this bill license all midwives?
This bill will provide licensure for the two types of midwives that are nationally recognized and meet the ICM criteria for a midwife who do not currently have licensure in the State of Hawaii.
8. Does this bill cover cover naturopathic (ND) midwives?
No, this bill does not cover naturopathic midwives. Naturopaths are licensed under the Board of Naturopathic Medicine. Their training does not meet the ICM definition of a midwife.
9. What about midwife assistants?
HB2184/SB2294 currently do not address midwife assistants. This is of a concern to Midwives Alliance of Hawaii. We will suggest language to include midwife assistants as part of the bill to ensure they can be part of the midwife’s team.
10. Does this bill require the midwife to carry professional liability insurance (also known as malpractice)?
No. Professionals are not mandated to carry professional liability insurance in order to be licensed.
If CMs or CPMs want to participate with insurance plans or obtain privileges at a facility they will have to obtain professional liability insurance, or if they work for an employer they will be covered under their employer’s liability insurance.
11. What is the NARM Bridge Certificate that some CPMs will have to acquire for licensure?
All organizations within US MERA, along with ACOG, recognize the Bridge Certificate. This certificate is specifically for CPMs who did not acquire a Midwifery Education & Accreditation Council (MEAC) accredited education. The Bridge Certificate is an additional one time 50 continuing education units in specific areas for CPMs to take after they have passed their NARM exam and been awarded a CPM certificate. http://narm.org/midwifery-bridge-certificate/
The continuing education credits must include a minimum in each of the following three categories:
a) Category 1: Emergency Skills in Pregnancy, Birth, and the Immediate Postpartum (Maternal) = minimum of 15 CEUs; at least 1 course with hands-on component
b) Category 2: Emergency Skills for Newborn Care (Neonate) = minimum of 15 CEUs; at least 1 course with hands-on component
c) Category 3: Specific Topics Relevant to Midwifery Care (Other) = minimum of 0 CEUs
12. How many other states regulate CMs and CPMs?
Currently 6 states recognize the CM credential: NY, NJ, DE, ME, MO, and RI. http://www.midwife.org/Essential-Facts-about-Midwives
Currently 33 states regulate CPMs, most through licensure: http://pushformidwives.nationbuilder.com/cpms_legal_status_by_state