11-04-2025
5 things to know about Hawaiʻi's mdwifery debate
HONOLULU (KHON2) — On Thursday, April 10, the Hawaiʻi State House of Representatives passed the third reading of House Bill 1194.
The bill has stirred quite the controversy from Native Hawaiian practitioners who believe they have a right to determine who provides medical care for their bodies. But no everyone is on board with this.
A storm of opinions has emerged from across the islands, and across generations. The bill, which would require licensure for most midwives practicing in the state, has drawn strong reactions from medical professionals, Native Hawaiian cultural practitioners and elected leaders alike.
At the heart of the debate is a question both personal and political: Who gets to decide how a baby is born in Hawaiʻi?
Hawaiʻi State Representative Lisa Marten, District 51, so-sponsored the bill with Representatives Linda Ichiyama, Scott Matayoshi and Gregg Takayama. It's aim is to save lives.
'I have a doctorate in public health and have worked in programs around the world,' Rep. Marten said. 'My perspective values health care that is evidence-based to provide the lowest mortality and morbidity outcomes for our mothers and babies.'
According to Rep. Marten, the intent of HB1194 is not to erase traditional practices, but to ensure safety and accountability, especially in the event of emergencies.
'Licensure offers standards which I believe our residents are worthy of,' she said. 'While a practitioner can bring other talents and traditions to the job, they should also have a basic understanding of anatomy, CPR and the ability to diagnose complications that require transfer to the hospital in a timely manner.'But critics see the bill as an overstep, especially in the context of Hawaiʻi's complex history of colonization and Indigenous resistance.
A joint report submitted Tuesday, April 8, to the United Nations called the bill a threat to Native Hawaiian birthing rights. Laulani Teale, a Native Hawaiian cultural practitioner and midwife, called it a 'major violation of human rights'.
'Our people are asking for the freedom to choose who attends them in their sacred space of birth,' Teale said. 'They are NOT asking for regulation. They simply want the right to decide who touches their bodies.'
Rep. Marten rejects the idea that HB1194 limits Native Hawaiian practices.
'The legislature has no place in regulating traditional Hawaiian practices,' she said. 'As such, the bill has a broad exemption for people of Native Hawaiian descent, as is provided for in the constitution. There seems to be a lot of cultural appropriation around this issue where people continue to falsely imply the bill restricts Native Hawaiian practitioners.'
Still, for many homebirth families and advocates, the bill feels like a door closing. In rural areas especially, where doctors and hospitals may be hours away, midwives are often the only providers available.
'I don't think people really understand how important midwifery is here in Hawaiʻi,' said Rep. Amy Perruso, District 46. 'We have rural areas where doctors and nurses are few and far between, and midwives are providing an essential service.'
But Rep. Marten said regulation would strengthen, not reduce, those options, particularly by expanding what licensed midwives are allowed to do.
'The bill allows licensed midwives to practice to the full extent of their training, which may include diagnosis, prescribing medications, and using medical devices,' she explained. 'We currently do not have birth centers, but the rules for that are being discussed to see if we can bring that back into our state.'
Still, the bill raises questions about who gets to define 'safe' birth. Teale and others argue that cultural safety is just as critical as clinical safety.
'Medical professionals are important; but they should not control the choices of birthing people, especially Indigenous people,' Teale said.
Rep. Marten has also heard the tragic stories from hospital emergency staff who say they've witnessed the worst outcomes from some unlicensed midwives.
'These are heartbreaking cases,' she said. 'Emergency care providers shared with me that the tragic cases tend to concentrate among a few practitioners. None they identified to me happened to be Native Hawaiian. But when one source of learning is flawed and that person trains others, the incompetence spreads.'
While HB1194 includes a pathway for apprenticeship training, a nod to hands-on experience, Rep. Marten worries it lacks guardrails.
'If someone trains under a provider with a history of bad outcomes, and that's their only source of learning, then they're going to carry those risks forward,' she explained.
Despite fierce opposition from some advocates, Rep. Marten emphasized she's not swayed by lobbyists or donations.
'I have no donations from any advocates around this issue on either side. I don't fundraise at all,' she said.
For now, the bill has been referred to the Senate committees on Health and Human Services (HHS), Commerce and Consumer Protection (CPN) and Judiciary (JDC). Each committee will review the bill, potentially hold hearings and may propose amendments.
If the committees recommend passage, the bill will proceed to the Senate floor for further readings. Should the Senate pass a version of HB1194 that differs from the House's version, a conference committee comprising members from both chambers may be convened to reconcile the differences.
Once both chambers agree on the final text, the bill will be sent to the Governor Josh Green M.D., who can sign it into law, veto it or allow it to become law without a signature.
You can click to learn more about HB1194.
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As Rep. Elle Cochran, District 14, oriented the debate: 'At the end of the day, it's about women's rights and safety and the need for access to healthcare services.'
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