HONOLULU (KHON2) — HB 1328 is a proposed bill in Hawaiʻi that aims to expand access to midwifery care and protect the reproductive rights of pregnant people, particularly when it comes to choosing their birth attendants and place of birth.

This bill is focused on ensuring that pregnant people in Hawaiʻi have the right to make decisions about their own healthcare. This includes the choice to have a traditional midwife, cultural healer or other non-clinical practitioners involved in their birth.

The bill is especially important because it seeks to end the criminalization of Native Hawaiian traditional birthing practices and other cultural midwifery methods that have been used for generations.

One of the core goals of HB 1328 is to support a pregnant person’s right to choose who attends their birth and where it takes place.

This is especially crucial for those who prefer home births or want to include traditional midwives or cultural birth practitioners in their birthing experience.

By ensuring that these choices are legally protected, HB 1328 respects the individual autonomy and self-determination of pregnant people.

HB 1328 also has the potential to expand access to midwifery care by recognizing multiple pathways to certification for midwives. Currently, midwives in Hawaiʻi must meet strict licensure requirements to practice legally, which may exclude many traditional or cultural midwives.

Under HB 1328, midwives could become licensed through an apprenticeship model or by passing a certification exam.

This change would make it easier for more trained and skilled practitioners to legally assist with births, especially in communities that need more midwifery care, such as rural or remote areas.

For Native Hawaiians and other cultural communities, this bill is vital because it protects traditional birthing practices that are part of their cultural and spiritual identity.

Many Native Hawaiian families use traditional birthing practices that often involve cultural midwives or healers. Under the current law, these practices have been at risk of criminalization; but HB 1328 would offer legal protection to those who follow their cultural customs.

Ultimately, HB 1328 seeks to ensure that pregnant people in Hawaiʻi have the ability to make informed choices about their births and the care they receive as a means of creating a system that is more inclusive, respectful of cultural traditions and supportive of diverse birthing options.

According to local cultural practitioners, here are 12 reasons pregnant persons in Hawaiʻi tend to choose midwifery to assist with their pregnancy, birthing and postpartum experiences.

1. Self-determination

In a home birth setting, the person giving birth has the ultimate say in how their birth unfolds. Their wishes come first, and they can make decisions about every aspect of the birth.

This allows for a deeply personal and empowering experience where families have control over their own birthing journey.

2. Family participation

Home birth allows families to be part of the birthing experience in a way that a hospital setting may not. The family can choose their birth team, assigning roles ahead of time.

This can include siblings, extended family members, and close friends. This level of involvement helps build a support system that many feel is essential for a positive birth experience.

3. Cultural traditions

Many cultures have their own traditional midwifery practices that are important for the well-being of families. For some communities, these practices are tied to their cultural and spiritual identity.

Being able to choose midwifery care that respects their cultural and religious traditions is an essential part of self-determination for these families.

4. Avoiding obstetric trauma

Unfortunately, some people who give birth in hospitals experience trauma. This might be from mistreatment, a lack of respect for their birth choices or difficult medical procedures. For many, birthing at home feels safer and more supportive.

This is especially important for Black, Indigenous and People of Color (BIPOC) families who statistically experience higher rates of mistreatment in hospitals. As a matter of fact, BIPOC pregnant persons die at rate of 2.6 times more than their white counterparts.

5. Access to care in rural areas

In rural areas, access to maternal healthcare can be difficult. There may not be a hospital close by, and getting to one in time for a birth might be impossible. In these situations, a home birth can be the safest option.

For many people in remote locations, the only other choice might be leaving their home and family for weeks in a hospital or evacuation birth, which can be hard on their mental and emotional well-being.

6. Personalized birth style

Every birthing person has their own vision for their birth experience. Home births allow families to create a plan that fits their desires, from the atmosphere of the space to the care provided.

This level of control makes it possible for families to have a birth experience that truly reflects their wishes and needs.

7. VBAC (Vaginal birth after cesarean) and other medical conditions

Some people who have had a cesarean in the past want to try for a vaginal birth in future pregnancies (VBAC). While this is often possible with proper care, many hospitals and obstetricians refuse to support VBACs.

In these cases, a skilled midwife might be the only option for a safe vaginal birth. Home birth with a trained midwife allows people the chance to give birth vaginally when medical providers might not support that choice.

8. Sovereignty

In some communities, particularly in Native Hawaiian communities, there are deep concerns about sovereignty and self-rule. Some believe that the state of Hawaiʻi is an illegally occupied entity, and birthing at home is one way to exercise their sovereignty.

For these families, midwifery care that honors their traditional ways of birthing allows them to take control of their own health and lives, outside of state systems.

9. Cost

Licensed midwifery care tends to have higher out-of-pocket costs compared to hospital births, especially for those who have good insurance. However, this isn’t always the case for everyone.

Some people may not have insurance, or their insurance may not cover certain hospital options, making them unaffordable. On the other hand, traditionally attended births are often more affordable overall compared to other birth options.

10. Hospital changes

Medical systems are constantly evolving, which means parents might find that the options they were offered earlier in their pregnancy are suddenly unavailable. Changes in doctors, shifting policies and various other factors unrelated to health or safety can leave families feeling uncertain about what to expect in the hospital.

As a result, some families may choose to birth at home instead where there is often more consistency and stability in their care.

Every person should have the right to decide what kind of birth they want and who will attend their birth. Restricting people’s ability to choose their midwife, birthing location or care provider goes against the fundamental principle of reproductive autonomy.

By expanding access to midwifery care, we can ensure that people have real choices in how they bring their children into the world.

Traditional birth attendants and cultural practitioners have a rich history of supporting births in many communities.

However, the law currently criminalizes many of these traditional practices. You can click here to find a midwife in your area.

Recognizing and protecting cultural and traditional birthing practices is vital to ensuring that people have access to the care they trust and feel comfortable with, without fear of legal consequences.