House Standing Committee on Consumer Protection & Commerce

Good afternoon. It's two o'clock, and I'd like to welcome you to this Joint Committee on Health and the Committee on Consumer Protection and Commerce. I'm Greg Takayama, Chairman of the Committee on Health, and like to welcome my colleague Representative Matayoshi, who is CPC Chair.

We have two bills before us, but let us, before we begin, take care of some housekeeping rules in order to allow as many people as possible to testify. We do have a two-minute time limit on testimony.

For those on Zoom, please keep yourselves muted and your video off while waiting to testify and after your testimony is done. If you're disconnected, you may attempt to reconnect.

In the event of a total network failure, which doesn't happen often but has happened, we may have to recess the meeting and re-adjourn when we are able to. For those on Zoom, please avoid using any trademarked or copyrighted images that'll take us off the air. And finally, please act with Aloha.

Please refrain from profanity or uncivil behavior for all testifiers, which I'm sure will not be a problem. So first up, let's see, we have first up we have house bill, both bills relate to midwives, first bill is House Bill 1194, and the first testifier we have is from the Department of Commerce and Consumer Affairs, DCCA.

Good afternoon, Chair Takayama, Chair Matayoshi, and members of the committees. My name is Alexander Pang. I'm an Executive Officer for the Department of Commerce and Consumer Affairs Midwives Program. We stand on our written testimony supporting the intent of this bill and offering comments, and we're available for questions. Thank you.

Thank you. On Zoom, I believe we have from the Maui County Council, Councilman Keani Rawlins-Fernandez, not present, in opposition. Hawaii Home Birth Task Force Chair and Collective, Kristie Duarte.

Aloha. My name is Kristie Duarte. I am the Chair of the Hawaii Home Birth Task Force and the task force was created because of the legislature's intent stated in the 2019 preamble that over a three year period the legislature would, quote, enact statutes that will incorporate all birth practitioners and allow them to practice to the fullest extent under the law, end quote.

I am in strong opposition to HB1194 because it does not incorporate all birth practitioners and lacks clear statutory protections for religious, traditional, cultural practitioners and birth attendants who do attend, supervise, and assist in births. Number two, I wanted to clarify any confusion there may be about the auditor report.

Right now, only an auditor summary has come out, right here it says the report is still pending, and it did not require mandatory accreditation in it. Rather, it did recommend mandatory licensure. And I wanted to point out that doctors who have mandatory licensure have exemptions, and nurses who have mandatory licensure also have exemptions.

So it's important that with midwives, they also have exemptions with mandatory licensure in place. Lastly, I serve as the President of the Hawaii Home Birth Collective, which represents the largest membership of licensed midwives under this law in our entire state.

We are in opposition only because it places restrictions on our licensed midwives by not allowing them the ability to practice to their fullest extent. We respectfully request that you defer this bill and pass instead HB1328 with its clear protections and ability for our licensed midwives to practice. Mahalo. And I will be here if there's any questions. Thank you.

Thank you very much. Next, we have the Hawaii Affiliate of the American College of Nurse Midwives.

Aloha. Thank you for having this hearing. It's a momentous day to have a whole session for two midwifery bills. My name is Margaret Ragen. I am representing the board of the Hawaii Affiliate of the American College of Nurse Midwives. I'm the secretary. I am also the only certified midwife in the State of Hawaii.

We strongly oppose HB1194 on the basis that it does not reflect national standards of ACNM nor state standards established for APRN CNMs, which is how it is in Hawaii, because a CM is equivalent to a CNM. So in Hawaii, it's an APRN CNM in the provision of midwifery care.

And we pulled in our work with ACM National. We pulled from Hawaii Administrative Rules 89-C language to establish our equivalence. We appreciate the attempt of HB1194 in its efforts to establish the CMS equivalence with the CNM, but it does not meet to attempt to amend 1194 so that it would meet equivalence.

So, for example, a CM could go to an institution and apply for a bylaw revision that added a CM side by side with an APRN and CNM to full scope equivalence would not be possible. It would have conflicts with Medicaid reimbursement.

And as well as obtaining prescriptive authority, we did receive some feedback in 1328 with questions about confluence of a prescriptive authority with a license requirement application. We have based our standards on Hawaii standards, so you can't conflate the two to make it easier on a department. So, can DCCA manage a prescriptive authority? We are not sure.

Can you please summarize your testimony?

Okay. There are also some valuable parts to HB1194 that merit consideration for amendment inclusion in 321328, and those include sections on healthcare providers, where the CM should be included. And we also included that in our written testimony. A direct quote of ACNM national on telehealth. And we provided.

Thank you very much.

Thank you for your time. I'm available for questions.

On Zoom, we have the Libertarian Party of Hawaii, Austin Shiloh Martin, please proceed.

Aloha. Thank you for having me. I stand on my written testimony, and I want to supplement it with a few thoughts. Consumers have a right to decide what kind of services that they want. They have a right to decide which kind of accreditation that they want to adhere to.

And this seems part of a larger push by the legislature in Hawaii to define and control culture, consumer behavior, and to try to mitigate risks by removing choices from individuals. And this troubling trend is causing a lot of public blowback and frustration with the legislature.

I know for a fact there's a lot of people who want to be here talking about this today, but only found out a little bit too late. We care about home birth, we care about women's rights, women's reproductive rights.

If we care about those things, we should not be requiring a license in order to practice what could arguably be rightfully dubbed the oldest profession for women. Let's not degrade that, by the way. So I would just point out, guys, that this is not a thing that needs to be regulated to the extent that it is.

I believe that currently the protections in place are enough, liability is enough. The only reason there's a problem is because the medical neglect statutes and others are being abused by the attorney general, by the administration, in order to persecute people who are only trying to seek medical freedom from state interference in their most personal decisions.

So I actually, I don't just oppose one of these bills. I oppose all of these bills and the entire concept of trying to force a licensure scheme on what should be the free activities of individuals. And I would encourage you to rethink the fundamental concepts that lead to this bill. On each of them, there's problems.

And this problem of creating a licensure for something that ought not to need licensure is, in my opinion, the root cause and should not be ignored. This is the state trying to gain control of over an industry, over cultural and religious practices. And I'm not okay with it.

Thank you.

My youngest son was born at home and, okay, thank you.

Next, we have on Zoom Midwives Alliance of Hawaii, Leʻa Minton, please proceed.

Aloha, Chair Matayoshi and Chair Takayama, and committee members of Consumer Protection and Commerce, and Health. My name is Leʻa Minton. I'm the Board President of Midwives Alliance of Hawaii, and I'm a certified nurse midwife. We thank you for this opportunity to testify in strong support of HB1194.

HB1194 is a bill to continue the regulation of midwives as the current law is scheduled to sunset.

And we support HB1194 because the State of Hawaii Regulatory Licensing Reform Act says that the regulation and licensing of professions shall be undertaken when it is reasonably necessary to protect the health, safety and welfare of consumers of the services and that the purpose of regulation shall be the protection of the public welfare and not that of the regulated profession.

Additionally, the state says that full licensure, meaning mandatory, shall be retained when the health, safety, or welfare of the consumer may be jeopardized by the nature of the services offered by the provider. What this means is HB1194 aligns with the state requirements.

Midwifery requires mandatory licensure of the profession, not voluntary licensure, because the services that midwives offer have inherent risk to consumers under their care. This was reiterated in the sunset analysis published in 2025 by the state auditor.

HB1194 strengthens the regulation of midwifery by ensuring the international and national educational standards for midwives are required in Hawaii, which is critical to ensure the safety and wellness of our families, mothers, and their keiki. We provided recommended clarifying amendments to HB1194 in our testimony, and we support ACOG's and ECAS's recommended amendments. We urge you to vote yes on HB1194. Mahalo.

Thank you. Next on Zoom, we have Malama Napua Ohamea, not present. Ohia Midwifery. Oh, I'm sorry, are you here in person? Thank you.

Aloha, mai kakou mahalo nui for the opportunity to be here together. Thank you so much to all of you who had part in scheduling both of these bills.

My name is Kiʻinaniokalani Kahoʻohanohano, and I am in strong opposition to 1194, HB1194. Although I am very grateful for the attempt, and also very much looking forward to creating more positive solutions, because that is what we need. So I do appreciate the attempt.

There are so many flaws that I'm not going to list them all. I think they've been very eloquently stated through so much testimony. So I just want to say that I'm here. I've been here for over a decade, and I would really like this to end.

I think that most of you probably have that in common with me. So let's come up with solutions. Let's see you folks as the champions of this issue this year. Let's make the changes that need to occur so that our families are no longer struggling. I reside in Maui County, Maui County.

Again, not just being Maui with one hospital, but being Lanai and Molokai. We already have a maternal health care desert affecting Native Hawaiians and Pacific Islanders, with the highest maternal deaths of any other race of any other people. We are already 50th in the 50 states in prenatal care, and the list goes on and on, as far as statistics to show that we need solutions.

The solutions are not to create limitations to access to care, especially in rural or low-income areas, which for over 20 years I personally have served with very safe and solid, beautiful births, outcomes. The most harm I've ever seen is outside of the home.

And at the same time, I want you to know how grateful I am for the folks that are there to catch you when you fall in all the ways. I'm super grateful for all of our medical interventions and technology that we do have. But birth is an innate process.

I am a mother of five home birth babies. I have caught hundreds of babies and always had beautiful outcomes. I work in communities that need me and do not have any access to care otherwise.

Can I ask you to please conclude?

Thank you so much.

Thank you so much. 'Ōhi'a Midwifery Wellness.

Aloha, again. My name is Margaret Ragen. I am the owner and staff midwife at 'Ōhi'a Midwifery and Wellness in Kealakekua, Hawaii. I am speaking on behalf of my partnership with two other CPMs. We are a group practice which includes a certified midwife and certified professional midwife.

We support the continuation of a midwifery licensing program for the benefit of public interest. We are aware of the widespread provider shortage throughout the state. We are concerned that HB1194 does not establish access to care as integral to public safety.

HB1194 limits access to routes to nationally recognized pathways to credentialing and for license maintenance, places further restrictions on the CM and CPM as compared to what is expected of other practices, such as an APRN CNM. HB1194 does not establish our credentials to the national standards of ACNM nor NARM under ICM recommendations.

In definition, neither in definition nor scope does it enable us to practice to the full extent of our credential, including prescriptive authority based on our credentials, and it does not pave the way for insurance reimbursement, so we continue to act on a cash pay basis.

Previously, I worked in an institute, a birth center, where I was fully credentialed in all insurances and provided full scope care. I worked through COVID, and we served all people in a pandemic.

If this was to happen again, we would not have a provision to serve all of the people who had no money to pay, and we saw this during the Maui fires and how deeply needed were the licensed midwives and all birth attendants.

Thank you.

We support legislation that allows for state-based students to achieve credentialing to enable them to serve the communities they reside.

Our practice participates in the provision of precepting for midwifery students to achieve their credential to serve the families of Hawaii.

Thank you so much. Birth Believers, Rebekah Botello.

Thank you for your time.

Thank you, I'm going to ask you to please wrap up.

Thank you all for being here today to deliberate on the issue of birth freedom. Let me say that again. Birth Freedom. For Hawaii's families today and into the future. My name is Rebekah Botello.

I stand on my written testimony and offer thoughts in person today to clarify why I'm asking you to strongly vote no on HB1194, a bill profoundly rejected by the community because it severely restricts birthing care and criminalizes family and friends who want to walk alongside birthing mothers and fathers.

I've been pastor community birth advocate, and worker for over 25 years in Representative Matayoshi's district. I represent myself, my husband, my children, my future grandchildren, and over 10,000 Hawaii birthing families who are all connected with our community education group called BirthBelievers. Birthing mothers and fathers are supremely intelligent.

They choose who they want to birth with who they want bringing their babies into this world and into their arms.

I've lost track of how many years I've been here to advocate for unrestricted access to maternal and infant care, whether that care be provided by a traditional cultural religious midwife, a family member, unattended birth, self-birthing situation, or by a Western medical birth provider.

While some in this building may try to convince you that HB1328 and 1194 are the same, that could not be farther than the truth. HB1194 is dangerous for birthing mothers and babies.

Restricting choice of maternal and infant care in the last 5 years because of HRS457J has forced birthing women to make dangerous choices for themselves and their babies, some deciding to birth by themselves without birth workers that they thought might be illegal and might be criminalized, and they didn't want to do that to those birth workers or, going to medical medical places where they feel that their bodies were being invaded by people that did not share their cultural or religious beliefs.

Thank you, I am going to ask you to please wrap up.

Yes, I'll close here. It's time to rectify the harms that were caused by restrictive HRS457J, and to listen to the thousands of community members that have testified year after year to make sure that they have birth freedoms that are unrestricted by this body or any other.

Thank you so much for your integrity and commitment to supporting our community voices. Mahalo.

Thank you, on Zoom, the Center for Reproductive Rights, Breana Lipscomb.

Aloha, Chairs Takayama and Matayoshi, Vice Chairs, and committee members. My name is Breana Lipscomb, and I'm the Senior Advisor of Maternal Health and Rights at the Center for Reproductive Rights, the only global legal advocacy organization dedicated to advancing reproductive rights, and I'm testifying in opposition to HB1194.

HRS457J, the state's current midwifery restriction law, is unconstitutional, which is why the Center for Reproductive Rights, the Native Hawaiian Legal Corporation, and Perkins Coie brought a lawsuit challenging it.

The state legislature now has an opportunity to strengthen recognition of reproductive autonomy, indigenous rights, and maternal health equity by creating a midwifery law that is better tailored to address Hawaii's maternal health needs. HB1194 will not end the lawsuit or resolve the concerns raised in litigation.

Instead, HB1194 infringes an individual's rights to make deeply personal decisions about pregnancy and birthday it imposes harmful restrictions on Native Hawaiian maternal health practitioners. It restricts access to skilled maternal health providers that communities already know and trust. It arbitrarily allows some certified professional midwives to obtain licensure while denying licensure to others who have earned the same credential.

It ensures Hawaii's dependence on a small and diminishing number of midwifery schools located in the continental U.S. with while denying current residents of Hawaii the opportunity to become a licensed midwife without leaving the state, and it subjects licensed midwives and their clients to poorly defined data collection requirements at a time when reproductive health data is increasingly weaponized.

Midwifery laws should create an enabling environment for the realization of human rights, rejecting efforts to further inject fear, stigma, coercion, and criminalization into reproductive health. And it should protect reproductive health choices and resources rather than taking them away. You all have multiple midwifery bills before your committees today.

HB1194 is not the solution. Mahalo for your consideration.

Thank you. Next, we have Banyan Birth, Taylor Hamill, not present..Pacific Birth Collective Kiana Rowley

Aloha, Chair and Committee Members, thank you so much for having us here today. My name is Kiana Rowley. I serve as the Board President of Pacific Birth Collective. We are a nonprofit organization who have grown to fill community health needs on Maui over the past eight years, and I'm here today to talk about.

We are in strong opposition for HB1194. Over the course of the past two years dealing with the Maui wildfires, the housing crisis, the issue with food insecurity, and many other issues facing our women and families, as well as the closure of important OBGYN facilities and the expiration of the birth attendant exemption which extremely limits access to maternal health care in Maui County.

We are in a crisis and it is a crisis that is exacerbated by our over reliance on a U.S. Medical system and policies which are focused and designed for much larger, more integrated medical systems, which is not true across the islands of Hawaii because we need access in our own communities to be able to train practitioners and to be able to receive the care that we need in our own communities without people having to travel far distances and having issues with transfer of care when necessary.

Our mutual goal today is safety. For most people familiar with hospital-based maternity care systems, we are used to high rates of intervention, routine inductions at 39 weeks, and lots of medicated birth. Because our dominant cultural framework, it can be difficult to understand community care. With a skilled midwife in unmedicated conditions, the risk factors are really much different.

And we need better data to show that home birth, unmedicated birth, is safe in a community setting with skilled midwives. We have recently been partnering.

Thank you, I am going to ask you to please conclude.

Yes, I would just like to stand on our written testimony around the EMS data related to the Department of Health, which shows that our home birth outcomes over the past 10 to 15 years are in alignment with national standards.

Even with the birth attendant exemption, it is not more dangerous for us to support our community, and we strongly oppose 1194. Thank you.

Thank you very much. Kiʻi Kahoʻohanohano. Oh, I'm sorry, you already testified? Okay. I don't know. Must be under a different. Okay, Papa, wait one second. Papa Ola Lōkahi. Keʻōpū Reelitz.

Aloha, Chairs, Vice Chairs, Members of the Committee. My name is Keʻōpū Reelitz. I'm the Director of Policy and Strategy with Papa Ola Lōkahi. You have our written testimony, and we're here for any questions.

I do want to note that our written testimony for both this and the other bill is strictly considering how it impacts our Native Hawaiian healers, our traditional Native Hawaiian healers, as is defined in both federal and state statute.

In this bill and HB1194, we do want to share that we do have concerns about the provisions as they relate to traditional Native Hawaiian healers. And so as you consider whether or not this bill moves forward, we ask that you consider either removing or amending it so that we can maintain the protections for traditional Native wine heelers here. For any questions, Mahalo.

Thank you. ACLU of Hawaii, Carrie Ann Shirota.

Aloha Chair Takayama, Matayoshi, and Committee Members. Carrie Ann Shirota, Policy Director on behalf of the ACLU Hawaii. We thank you for scheduling this joint hearing on both bills. It provides lawmakers and communities the opportunity to review, compare, and reconcile both bills.

It sends a message to our community that we collectively care about protecting reproductive rights and improving maternal health outcomes in Hawaii, recognizing that midwifery care and access to it plays a significant role in improving those outcomes.

Given ACLU Hawaii's mission to protect our Constitution, we are submitting testimony in opposition to this measure, and we're going to focus on those specific provisions. Number one, at the heart of this measure is reproductive rights, which includes protecting one's right to choose where, how, and with whom individuals experience pregnancy and childbirth.

This also overlaps with the constitutional right explicitly protected in our Constitution to privacy. The bill continues to restrict these reproductive rights by excluding the apprenticeship pathway to midwifery licensure, despite the fact that NARM, the North American Registry of Midwives, which issues the Certificate for Professional Midwifery Credential and is accredited by the National Commission for Certifying Agencies.

Of note, 27 states in Washington, D.C. allow for this apprenticeship pathway upon successful completion of the NARM exam, that even individuals that pursue a midwifery schooling are required to take, which means that whichever pathway, there's still a basic minimum of qualifications. Less pathways to midwifery licensure means less access to midwifery care amidst the maternity desert in Hawaii.

It also means less workforce opportunities for those in our community that are unable to various reasons to travel to the continent to a midwifery school for finances because maybe they're taking care of other family's members. As drafted, the bill violates Native Hawaiian traditional customary practices, which is affirmed in our constitution and case law. And we have.

Please conclude.

Yes. And we'd also like to note that there are clear exemptions that, if this bill proceeds forward, we would like to see included so that individuals and groups are not subject to criminal fines and penalties, that we include an exemption for Native Hawaiian practitioners religious and cultural practices.

There is the right to practice your religious beliefs within the context of birthing.

Birth attendance, but also requiring DCCA requirements for disclosure, as we talked about, doula's lactation specialists, and extended hanae family.

Thank you.

Thank you. Can you please wrap it up?

We just like to share with all of you that there has been a lot of controversy surrounding these issues for the number of years. And I'm really grateful that we all came here today in a bipartisan spirit to work together to pass the best bill for our community because literally mothers' lives are at stake. Thank you, Chairs.

Ronnie Texeira.

Aloha. My name is Dr. Ronnie Texeira. I'm the Chief of OB at Straub and a practicing OBGYN in the Winward community. My testimony is not representative of Straub, but as a physician, a concerned community member, I strongly support HB1194.

OBs and midwives alike agree that a woman should be able to make her own decision with informed consent as to where she'd like to give birth.

This is a bill that pertains to the safety and competency of that licensed midwife is able to provide as well as a means to hold that midwife accountable for any practices that do not meet the standards of care in the community, if she in fact wants to be known as a licensed midwife.

The reason physicians are so passionate about having midwives licensed is because of all the preventable bad outcomes we are seeing in the hospital every year.

I had a patient myself who has midwife didn't make it to her delivery, send her apprentice who was on an apprenticeship pathway who didn't know how to do a vaginal repair and did it anyway. If that apprentice midwife had the proper training or had just sent her into the hospital for the repair, she would have been fine.

But I believe she lacked the training to know when to send that patient into the hospital. I had another patient who was allowed to labor with a headache and elevated blood pressures, which are clear signs of high blood pressure pregnancy that could lead to preeclampsia.

They're both life-threatening conditions the midwife either ignored or did not have the knowledge to recognize it. The mother then needed to be admitted to the hospital postpartum for a few days and be away from her baby the whole time.

She was also told to go to Castle Medical Center, which does not have high risk OB there at the time. So she was also told to go to wrong facility.

A family member just came up to me last month and said she labored for over 24 hours with her friend, and they kept changing her pad that was filled with green fluid until the midwife finally took her to the hospital. She ended up with a C-section and was septic.

Her baby was transferred to the NICU, and they didn't know how to report that midwife. They were so upset, but they didn't know where to go. Those were all clear signs that a baby and mother were in trouble. The other concern I have is for the babies being born at home.

The majority of the complications that come to the hospital actually involve the baby. Most babies will live, but I can't say what kind of quality of life that child may have. This is actually one of the reasons OBs are held accountable for up to 18 years after a child is born.

I don't believe this is a native Hawaiian issue. Native Hawaiian practices are already protected by the Constitution. It's very easy to make many issues Native Hawaiian, which upsets me as a Native Hawaiian. I just think I'm going to wrap it up. We just can't rely on apprenticeship pathway, women. Health is changing.

Thank you.

Women are dealing with diseases that our former practitioners, midwives, do not have to deal with. We have increased diabetes, high blood pressure, obesity, gastric bypass, multiple gestations, advancing maternal age, and they all come with complications.

So we can't just rely. We have to have good standards of care.

Thank you, Doctor.

Thank you.

On Zoom, we have Bliss Kaneshiro. Please proceed.

Hi, my name is Bliss Kaneshiro. I'm a practicing OBGYN and I've been practicing in Hawaii for the last 18 years. My views are my own and don't represent any of the hospitals that I currently practice at. I'm here because I personally cared for patients who were harmed when an unqualified provider attempted to deliver their baby.

I've cared for many of these patients, and one of them stands out to me. She was a woman who was laboring at home for three days and came in after her baby passed away sometime in labor. The thing that stands out to me is how she described her baby's fetal heart rate.

She said the attendant was periodically monitoring the fetal heart rate, and she and her husband could hear it. She described it to me. At first, the heart rate went down only with contractions, but then it stayed down for longer, persisting even after the contractions finished.

These sound like late decelerations, which means that the baby's not getting enough blood flow. As her labor went on, the fetal heart rate decelerations got longer and stayed persistently low until they could no longer find the baby's heartbeat. And that's when they decided to come in.

She said that she questioned the person attending her birth and asked whether the baby's heart rate should be so low, and was repeatedly given reassurance and told to wait a bit longer. Birth should be an empowering experience, and this includes providing women with the information they need and access to trained providers.

Of note, because she delivered her baby in the hospital, this fetal demise was recorded as a hospital birth, even though the events that led to the demise took place outside the hospital. I support patients being able to deliver their baby with the provider they choose and the place they choose, including their home.

But they deserve accurate information about their provider's qualifications, and they need providers who can accurately assess the clinical situation and recognize when it's appropriate to come to the hospital. I'm in strong support of House Bill 1194 because it supports patient choice. Thank you.

Thank you, Doctor. Next up, we have Alana Koa.

Aloha. My name is Alana Koa. I come from the island of Maui. I'm strong opposition of HB1194. I am also a member of the Hawaii Home Birth Collective as well as a Haumana Apprenticing under Mālama Nā Pua O Haumea. I'm an inspired midwife and palekeiki.

Reason why I'm in opposition of this bill is because it does not protect me as a kanaka. It does not protect my cultural rights. HB1194 will make all customary practices regulated by the state, if no one knows that. Overriding our rights in the Constitution to practice.

It limits pathways of getting licensed, for people like myself, it's going to be really hard to I have to move off island, spend a lot of money, and learn in an area that is foreign to me. It restricts our licensed midwives here, and we are in a crisis. And this bill, 1194, will amplify the problems rather than solving the issues.

I'm here for the wahines and the families that have traumas and are not happy with the medical health care that we have here in Hawaii and on Maui specifically. There is a midwife for everyone, and it is the choice of the person giving birth, of whom where, and how they want to give birth. It is their choice.

They should not be getting consent from somebody else of how they want to give birth. And I am a mother. I gave birth alone in the car.

I had my own traumas with our healthcare, but I remember who was there for me, and it was my mom, my aunties, family members, midwives that were the only ones being able to reach me and give me the care that I needed.

So I had a really good experience with midwives, and I've seen a lot of great experiences with them, too. And I hope that there can be a choice for everyone to have that experience and that care that everyone's accessible to.

Thank you.

Mahalo for your time and your consideration.

On Zoom, Dr. Casandra Simonson, please proceed.

Hi there. This is Dr. Casandra Simonson. I'm a pediatrician in Maui, where I've worked for underserved and Native Hawaiian keiki for over 10 years. And speaking today on my own behalf and not representing anyone else in strong support of HB 1194 in order to hopefully save some moms and babies.

I recently had a lovely family bring their baby to me at about a month old. The mom was so excited to show me a video of her home birth. She delivered standing, and I watched baby slip right out onto the floor. And I have delivered five babies myself. They are so slippery. That part didn't worry me. What did was that the lone birth attendant, I don't know who, continued to work on mom pulling hard on the umbilical cord to try to remove the placenta while the baby on the floor was blue, not moving, not breathing, getting colder by the second.

I watched time tick by on the video and finally, no one told him to, but the dad went over and picked the baby up, gently rubbing its face in its chest and it finally gasped for air. The family felt this was an amazing natural experience. Meanwhile, I'm still quietly monitoring the baby for cerebral palsy.

It takes time to show up. Birth is natural, but so is death. According to the WHO, one in 16 women in Africa still die in childbirth today. I have another patient, now a teenager who should be joking around with his twin sister and learning to drive. But instead she died at birth and he is vegetative.

He doesn't move, eat, or speak, and it's not clear he can see or hear. He startles like a newborn when touched. The result of a twin home birth far away from our only hospital. I often have moms come to me after home birth very scared. Most often their milk isn't in, baby is weak or her has turned yellow from jaundice. And the home birth package they signed up for that was supposed to include newborn care they didn't get because they couldn't pay. They feel abandoned.

Home births and newborn care are being sold to moms, but birth is not a you get what you pay for situation. This bill, HB 1194, will help put up a guardrail that sets standards and has accountability. Guardrails are needed for very slippery babies. Thank you.

Thank you, doctor. Also on Zoom, we have Sierra Dew. Not present. Nadine Ortega. Nadine Ortega. Pahnelopi McKenzie.

Hi, everyone. I thank you for holding this meeting today and having the joint commission. We all know that mothers' and baby safety is the most important for all of us for a healthy future and a healthy society. Hawaii has shown excellence of care, and prenatal care, postpartum care has been excellent in the Hawaiian Kingdom.

I'm strongly in opposition to HB 1194. It's completely based on clinical midwifery and excluding all other midwiferies outside of a western model of care. We should have all midwives. All midwives need to be respected. All midwives have a place to their full capacity of care.

HB 1194 devalues and erases the spectrum of what a midwife is, what they do, and how they are trained. I hear these OBs, I hear these stories of unsafety. I work in domestic violence. The amount of stories I hear from the women being violated, harmed, and neglected in this medical system is unbelievable.

I also know so many midwives that stay up in the middle of the night and take care of those babies while the medical establishment does nothing. So this safety concern, we're all concerned about safety, but it's not about this blame or that blame. The mothers and children need to be the priority.

And this bill creates a further maternal health crisis. A midwife is broad care and clinical midwives and traditional midwives working together is what we need. We need prayer, we need safety, we need accountability. And this bill does not create safety. It does not protect reproductive rights.

And the consent of the birthing person is not the focus at all in this bill. There is no evidence that restricting midwives makes anybody safer. ACOG gives a statement. 60 to 80% of unnecessary deaths are happening in our hospitals. These numbers of death, the maternal crisis is in the hospital. It is not home birth.

We need everybody, we need everyone to work together. And a midwife is a global spectrum. It is not a clinical setting. It is a global person that takes care. We see midwives from around the world. And this western model of racism, eugenics, and violence that's happening has to be stopped. Please oppose 1194, as this is not the solution to ending this maternal health crisis. Thank you for your time today.

Next we have Rachel Curnel Struempf.

Aloha, Honorable Chairs and Committee Members. My name is Rachel Curnel Struempf. I'm the first licensed midwife in the State of Hawaii under 457J, and as such, I'd like to thank you for the opportunity for a license. We really appreciate the intent of the state through the program. However, as we all know, the bill itself has some shortcomings.

I do appreciate the attempt of rectifying those with HB 1194. I will say I'll start off out of the bat saying what I like about the bill. I love the global authority signature. That's wonderful. It allows us to put our patients on TDI if they're having issues pre-birth or something like that.

So that was really a really pono thing to put in there. However, where it falls short is more than 50% of the certified professional midwives are PEP trained. The portfolio evaluation process is how I myself obtained my certified professional midwife credential. It's a valid pathway to credentialing, and we all take the same exam when the time comes.

We have our credentials, our education, our skills, all of our classes that we've taken vetted by NARM prior to being allowed to take the NARM exam. But the NARM exam that's issued whether you've gone to a school or you've been apprentice trained is the same.

That said, my preceptor, the woman who's responsible for me being here today, April Bailey, is no longer legal because the exemption expired. And I'd like to explain how the exemption provides regulation. To be exempt, you have to follow the criteria for the exemption, which is to give the informed consent form and to follow the steps that are set forth in the law. And if you fail to do that, you are not exempt.

So thereby, if you follow the exemption and you are exempt, then you are regulated because there are rules that you have to follow and that ensures that we have safety for people who are birthing at home. The other thing is it's legal to birth at home alone. Absolutely, positively alone by yourself. And so if I want to have my auntie who's helped her daughters or her aunties, we should be able to have who we want to attend with us whether or not they're credentialed. So thanks for your time.

Thank you very much. Pua O Eleili Kelsi Pinto on Zoom. Please proceed.

Aloha. I'm Pua O Eleili Pinto, a Native Hawaiian cultural practitioner of lāʻau lomi and lāʻau lomi and birthing. And I strongly oppose this bill, as it imposes, 1194, imposes a western medical framework and methodology that excludes traditional Hawaiian healing in the definition, saying that pale keiki and all the healing practices are not a part of what midwifery is.

And so this undermines ancestral practices and what we've was already established in the court cases. But what I've been hearing today are these really horror stories from OBGYNs and home birth doctors. And that is a really unfair disadvantage that that does not give the full scope of what home birth is about.

Because as someone that treats a lot of people that have had hospital births, majority of my patients have trauma from western medicine, birthing in the hospitals, medical, physiological, trauma, all of that on both sides. So that ability to really view home birthing as a problem and the practitioners outside of the hospital is this unfair disadvantage that how we should actually be working together, not trying to point blame. And so again, this bill really undermines what actually could be helping. That's in 1328.

And so in the court case of Kahoohanohano versus State of Hawaii, it really puts rules the affirmation that we possess comprehensive knowledge and skill sets and that it should be included in this definition. As well as in 1194, it states that Native Hawaiian cultural practitioners should have to report in written and in verbal ways that we have to report that our training is not approved by the State of Hawaii and keep this paper for 10 years. This is an unfair disadvantage.

How is this helping the already outside of hospital care, we don't have any resources to help with accounting or any other things like ads in hospitals. And so why is this bill imposing more restrictions on Native Hawaiian cultural practitioners instead of helping the situation. Again, the maternal health crisis, because the majority of people birth in the hospital and trauma is now synonymous with birth. We are not the problem. And so can you please take out these exemptions that cause unfair and create...

Thank you. Thank you very much. Thank you. Hope you're not driving. Thank you. Jennifer Kratzer in person. On Zoom, Kehaulani Avicolli. Not present. Caitlin Reposar on Zoom. Not present. Kadi Verhaeghe. Oh, yes. Thank you.

Aloha. I'm here from Maui. I am a traditional midwife from Maui since 1981. So I guess I'm the one that you guys are kind of looking at to what's going on. And this bill right now is really not the one that we've ever wanted to have. It's not safe. It doesn't go for the cultural beliefs, doesn't go for Hawaiian, and it doesn't even make it good for the girls that are trying to become midwives to be licensed. Midwife Alliance of Hawaii started a long time ago in 1981. It is not what we started to bring forth for saying it was legalization. It's not.

The other bill is the one we would like to see. I have daughters and I have eight kids and 13 grandkids. So we live on Maui. A lot of these people, they just want to have births to choose who they want, how they want to birth, and be safe. We love our hospital, Maui Hospital.

It's the only one we got. And our doctors have pretty much, you know, we're all here together to be part of one. And I just, this bill's not the bill to look at. You need to look at the other bill. And thanks for your time. I didn't really know what to say to you guys because you hold so much power, but this isn't the one for the people of Hawaii. This is not the bill you want to have for. You want to look at the real one and try to make better exemptions. Mahalo.

Thank you. You said it very well. They should be. Morea Mendoza.

Aloha. I'm actually on Zoom.

Okay, thank you. Please proceed.

Aloha, state representatives. My name is Morea Mendoza, and I'm here to testify in opposition to HB 1194 as a mother of Maui. The thing that I need for you to hear today, coming from the most respectful and heartfelt place possible, is that you don't care about my safety, the safety of my children, and of my family more than I do. You don't care about the safety of my family more than I do.

Just as I could never claim to know more about the deeply personal details that you make for you and your families. We're all here today to contribute what we can to a discussion about a midwifery program that is in dire need of reform. But what I want you to have in mind is that mothers like me from all around the state are the ones that are directly impacted by this law, not just the professional livelihood of unlicensed birth workers.

It should be at the forefront of your minds today that we are making decisions that have the potential to hinder a person's right to reproductive freedom. Reproductive freedom is not only the choice not to reproduce, but is also to have autonomy over our own decisions about our own bodies and who has access to them.

And so when I say that it feels safest for me to choose an unlicensed traditional provider with over 20 years experience who is recommended by my chiropractor, who has delivered my cousin's babies over a licensed provider who has just moved recently to Maui, who has been practicing for maybe five years, reproductive freedom would mean that that's my decision to make.

It is important to note that HB 1194 is inherently against reproductive freedom because it imposes restrictions that ultimately limit an individual's ability to make personal decisions about their reproductive health by creating barriers to licensure that are felt most deeply by the midwives of our communities.

Not all traditional midwives are Hawaiian, and this bill neglects to protect midwives of other cultures. Additionally, it narrowly defines what family members are allowable at a birth, which is the major overstep of personal freedom. I would like to thank the Chairs of the Committees for scheduling both bills for hearing. I know that just based on the number of representatives here today that are introducers of this bill, that the midwifery licensure program is a great priority for you as well. But I urge you to defer HB 1194 and instead support HB 1328. Because the decisions you make today will directly impact the safety, autonomy, and dignity of birthing families across Hawaii.

Also on Zoom, we have Carie Kwan. Not present. Adaure Ezinne Dawson on Zoom. Please proceed.

Aloha. My name is Ezinne Dawson. I'm a licensed CPM that is currently practicing on Oahu. I would like to first say that thank you for the opportunity to testify today and also would like to mention that I would like to strongly oppose HB 1194. I also want to stand on my written testimony with adding a few additional pieces. The first thing I wanted to add is that as a licensed CPM who became licensed through the PEP pathway, I am very disappointed that 1194 has focused on only one pathway to become a licensed midwife.

Myself, personally, I've been practicing and I've never had any of the negative outcomes that many of the testifiers have suggested are occurring with those who have been trained in a different pathway. And the last piece I'd like to add is that for every of the terrible, unfortunate outcomes that some have shared today, every single home birth practitioner, traditional practitioner, native practitioner can probably share a whole bunch more of those negative stories and outcomes.

And that is the reason why our families are choosing not to go into the hospital to birth. And I just want to say that we do not control life. We do not control death, but we do control respect. We do have the opportunity to support our communities, and we do have the opportunity to listen to the voices of the people and honor the culture, honor the culture of those who are around us and listen to what they are asking for. Thank you for this time.

Thank you. Thank you very much. Also on Zoom, Chris James. Not present. Daniela. Not present. Erzsi Palko. Please proceed.

Hello. Aloha to the Members of the House of Representatives in this Committee. I'm here as someone who found out about this bill less than 48 hours ago. And when I read, when I took the time to read bill 1194, I actually felt a sense of terror. I felt a sense of terror as a woman who was born and raised on Oahu who firmly believes in the right of a woman and her husband, her family, to hold the birth of her child, of their child as sacred and to have the right to informed consent and reproductive freedom in the light of... Like, I think I heard another person say, holding that birth with more love, with more love and care than I think anyone else on the planet could.

So when I hear a law where the state is trying to come in and restrict rights around that, it actually triggers terror. So I am not as prepared as I wanted to be today. But some points I wanted to bring up was that I am worried about restricting the only legal birth attendants to be those trained in the western medical model, especially only those trained through one pathway to the western medical model, and negating the expertise and experience of doulas and cultural practitioners who have connections in the islands.

It's a small place. If you mess up as hard as some of those OBGYNs were saying, you're not going to practice anymore. The community is going to stop that really fast. And it's terrible that it's happened, but this is a small state where people talk to each other. Also, I was concerned about language in the bill that kept repeating that there was going to be a director who was going to override any national standards or anything.

So it worries me because if you put this law into place, whoever that director is, and I don't know how they would be elected, you know, at the stroke of a pen, they could change the standards for care for births, like, outside of the hospital. And I don't, you know, I would want that to be regulated somehow, the powers of the director.

Thank you very much. Next we have Briana-Rane Keo.

My name is Ka'ili Keo, and I stand in support of HB 1194. As a kanaka, I am committed to our lahui and the safety and health of our kanaka and lahui. I have practiced as a labor and delivery nurse for 15 years prior to becoming a certified nurse midwife. Yes, I have lived here my entire life.

I'm born and raised here, and I got licensed as a nurse midwife. And I'm practicing currently as a nurse midwife at Kaiser and my views are currently my own, not of Kaiser. I have witnessed complications and deaths in the hospital that could have been prevented if recognized sooner by lay midwives, unpracticed traditional midwives.

Not frowning upon our traditional practices. I attended a CNM license because I have seen so many complications and death. And a lot of them, like we have heard today, are Native Hawaiians. The Native Hawaiian mortality rate for mothers and babies is horrifying. It's horrible, and I don't want to see it anymore.

Our aliʻis seen it back in the day and we need to stop it. Standards need to be set to protect our wahine and keiki in their most vulnerable states. Most of the people who are practicing as midwives are not kanaka. We can still continue our traditional practices and be held to a specific standard. We may continue our traditional practices in conjunction with state with safe care and ensured by professional and licensing standards. Mahalo.

Thank you very much. On Zoom, we have a Wyonette Wallett. Please proceed.

Aloha, everyone. Aloha kakou. My name is Wyonette Kaleialoha Wallett from the island of Maui. I strongly oppose HB 1194. I support HB 1328. We have submitted over many legislative sessions facts, reports, testimonies from a wide range of diverse people and certified professionals stating the skills and safety of these birth practitioners are essential to the health of our community and perpetuity of many cultures.

I come with a voice as a native daughter of Hawaii with allegiance to our Queen Liliʻuokalani and now with full authority to speak in behalf of my precious Hawaiian people and the descendants hereafter. I am a practitioner of pale keiki hula, which also was once outlawed.

Oli, lomilomi, la’au lapa’au. Bill 1194 directly attacks me, my way of life, and my cultural rights. I come from a place where I still have the house that my members of my ohana were born in. It still stands. This house is where my kupuna was birthed in by pale keiki.

And now I have that inside of me to be the next lineage and practice my Hawaiian religious freedoms and practices. I hold the knowledge, the oli, the skill to be pale keiki and have many other well qualified colleagues to assist me with this. To embellish on my aina. Our family has legal cemetery. We malama our kupuna.

We take care of our people from beginning to end. And this bill is racist and will interfere with my practices. We also have an ancient birthing stone on the same river we fought for because they threatened to take that too. The group of people that imprisoned my queen.

This currently feeds our lo’i, which I practice, which I am a practitioner of lo’i kalo as well. People like me do exist and need to continue, unless your point is erasure of my people and cultural practices in Hawaii. Our language is protected by the State of the Constitution, which we had to fight for that too.

And now everyone wants to Ōlelo Hawaii because it's awesome. Trust that my people amazing. If we don't protect our practices, then we just become vestiges of a people that once was, and our language will just be English with Hawaiian sounds. We need the cultural practices and the ceremonies and that's the way that the language continues. You don't need to pick and choose convenience and what is cute for you, it is all. The process of internship is much like you sitting there with your power. You are vetted, you are engaged with community, and community lifts you.

Can I ask you to please conclude?

So I say that this bill... So taking away this knowledge and birth practitioners from our community would criminalize us and prove to be one of the most disastrous bills for the health of our people.

Thank you. Thank you very much. Next on Zoom, we have Kaiana. Not present. Karin Omahony. Not present. Trinette Furtado. Shannon Matson. Please proceed.

Aloha, Chair and Committee, Vice Chair and Committee Members. My name is Shannon Matson. I was born and raised on Hawaii Island and I am currently in my second trimester of a pregnancy. I have had this baby that I'm carrying is not my own. I am serving as a surrogate, and I have had two successful, wonderful home births.

And this child that I am carrying now, due to the contract I signed willingly, will be born in a hospital as long as everything goes according to plan and hopefully not on the side of the road on my way to the hospital. I am dreaming of a world where midwives and our hospitals can work hand in hand.

I am not looking forward to my hospital birth due to prior experiences I have had in hospital situations. While I am grateful for western medicine and while I am willingly choosing to deliver in a hospital, I really wish I could have my trusted midwives and doulas and all of them at my side, as I was blessed to have in my prior births. I do not support this bill.

I do support the other bill that you'll be hearing next, and I'm hoping to offer some testimony on that as well. But in case I am not on the call any longer, I just wanted to correct for the record my testimony on HB 1328. It looked like it showed up as opposed on the record, and I am in strong support of that bill. So I just wanted to correct that. I do stand on my written testimony on both bills, again, in opposition to this one.

I think we need to do more and work harder to get a bill that we can get both the midwives and the OBGYNs to be in support of, and I believe the other one is closer than this one is. Thank you so much for your time, and I will be on the call for questions if there are any.

Thank you very much. Now that's all the, that's all the testimony we have submitted. Is there anyone else in person who wishes to testify? If so, please step forward and identify yourself. Please step forward. And if there's anyone else, could you line up the podium, please?

I have copies, written copies for you.

Can you give it to our Committee Clerk, please? Thank you. I'm sorry, you have to do so from the microphone so everyone can hear you.

Okay, let me get my glasses.

And if there's anyone else here in the, if there's anyone else who wish to testify, please line up behind me. Thank you.

Okay. Thank you, Chair. My name is Liko-o-kalani Martin. I am testifying in relation to the House Bill 1328. Let's see. With respect to reservations. All of you have taken an oath to uphold the United States Federal Constitution. A duty to render service, to uphold constitutional statutes and federal constitution, heads of departments and to hold invalid any state law practice deemed inconsistent with any international treaty obligation. 1993 acknowledgement of apology. Illegal overthrow resulted in the suppression of inherent sovereignty, deprivation of self determination. United Nations adopted a convention of prevention of punishment of crime of genocide.

United States Public Law 10606 Proxmire Act. Genocide defined, acts committed with intent to destroy in whole or in part national, ethnic, racial, religious group causing them serious bodily harm, mental harm, intended to destroy the group. Preventing births and forcibly transferring children out of the group. Criminalizes complicity or incitement of its commission.

Authorizes International Court of Justice to expel. You do not have a treaty of annexation and enforcing policies of apartheid by distinction. Prohibited from engaging in genocide, tried regardless whether private individuals, public officials, or political leaders with sovereign immunity. Preemptory norm no government can derogate. May 31, 1894. To recognize the right of the people to Institute their own government under a military power against which they are powerless to protect themselves.

Obligation of the United States to tear down that oligarchy established by force. Perpetuating the myth of the overthrow deceiving the honest American people of the Hawaiian Islands under a military do not have can protect themselves. The perpetuation of the fraud. 1897, the protest of Liliuokalani. Kūʻē petition in a protracted and perpetuating condition of civil war by involuntary servitude.

Thank you, Mr. Martin.

No records exist of the formal abrogation of the treaty. 59 equal footing you must. The US has not fulfilled its commitment to the acknowledge the ramifications.

Thank you, Mr. Martin. We have the rest of your written testimony. Thank you so much. Next up, please. Please identify yourself.

Aloha mai. My name is Violet Napualei’ilima Kapōhaiali’iokamāmalu Moanaliha Aarona. I was born and raised on the island of Maui and currently reside in Waiohuli Hawaiian Homes. I am an apprenticing pale keiki and traditional midwife under my Aunty Kii Kahoohanohano. I work in education and outreach for my community.

I'm a member of Hawaii Home Birth Collective and Malama Na Pua o Haumea. I am here in opposition of bill HB 1194. Although made with good intention, is still not a solution. It not only adds additional requirements for already licensed midwives but further requires mandatory data collection and an excess amount of additional restrictions on supervision and clientele. Clients have to pay out of pocket for care they may need. And if they can't, then what? We don't serve them? Hewa. It also makes all customary practice regulated by the state, overriding our rights in the constitution to practice.

So we are not covered by the Constitution as kanaka unless you fight and fight and fight to prove you should be. La’au lapa’au, lomilomi, Ho’oponopono, Oli, Hula, all the things that make us kanaka once again regulated and controlled by those who won't even hear us. To be a pale keiki is to understand these regulations only put us down. Continuation of these regulations will not only have us lose more 'Ike and kokua in this birthing world, but kupuna will and have died.

Being scared of being illegal, not being able to pass on so much knowledge. This is diminishing practices. To support this is to be against us. I am 19 years old. I want to be a mother and a future pale keiki and a traditional midwife. This is my future you are deciding, and I'm standing here fighting for the right one. This bill is not it. Mahalo.

Thank you very much. Next up... I'm gonna. Please, please, no applause. If you're gonna... Thank you.

Aloha. My name is Pi'ilani Schneider-Furuya. I am a student midwife, and I'm on the path of the PEP process, which is being considered as an illegitimate path to becoming a licensed certified midwife. I'm here in opposition of 1194. I respect some of the personal stories that some of the physicians and hospitals have shared today.

I feel like it really touched home for me because it made me feel like those stories were trying to make us all feel in this room that home birth is unsafe. And that's not the fact. We know that birth itself is very, very... We can't control it. So I just want to remind some of those physicians that there's scenarios that take place in a hospital setting that they also can't control. And I know of a few very scary scenarios that have happened this year that could have not happened if those physicians and nurses didn't make specific decisions that they made.

I'm here in opposition of 1194, and I just want to clarify that home birth is a safe choice for those that choose to make that choice. And if a birth needs to be transferred because there is a need for higher level of care, we make those decisions. Thank you.

Thank you. Next, please.

Aloha. My name is Laulani Teale, and I'm from the Ea Hānau Cultural Council as well as Hoʻopae Pono Peace Project. And first of all, I would just really like to sincerely thank all of you for being here and for having this hearing, particularly the Chairs, Representative Takayama and Representative Matayoshi. Thank you so much for scheduling this.

I know it's such a busy time, and it's really appreciated. I do want to say that as a cultural hanau practitioner, I am one of the people who is criminalized by the existing law, HRS 457J. And by this proposed bill, HB 1194. What I really want to talk to you about, I also just have to throw out because I didn't hear it earlier that in what Pi'ilani was saying about being these Hawaiian PEP students. This is the only locally available pathway to that practice.

And how serious that is can't be over emphasized because we have in the licensure, there are no Kanaka Maoli have achieved licensure in those five years under HRS 457J. Yes. I'm sorry. And in that time, yeah, none have achieved licensure, and there's no path that would allow them to achieve licensure. So it's just not feasible for local people because of the training that begins.

People start to become midwives when they have their own children. So we're talking about mothers with very small children for the most part, other than some of our awesome young folks who've started even earlier. But that's just not a time when local families can go move somewhere and learn from somewhere else. So one thing that I absolutely have to address are the horror stories. Because I'm a person. I'm probably the main person who gets called when things happen on the island of Oahu.

So I really need to address this because it's important that the reason that hospitals see these horror stories is not because cultural midwives or any kind of traditional midwives is dangerous. It's because there are a lot of, there's been a huge uptick in unattended births that are not attended by an actual midwife.

So when they hear that there are people coming in, it is very often not midwives who are attending the births, but they're just kind of throwing it together. Because as we know, when you restrict reproductive choice, then what you get is unlicensed, you know, underground practices.

Thank you for your testimony.

Okay, I'll continue on the next one. Thank you so much.

Is there anyone else in the room wishing to testify? Please step forward.

Aloha, everyone, for coming here today. Everyone's time. My name is Her Royal Highness Princess Shoshana Ariel Ka'akaualaninui Wilcox. And I am opposition of this bill and support all of our midwives here today. Because why, as aliʻi nui representing the royal family of Hawaii, we have done things the old way. We have westernization come in.

Yes, it has had its play out where it has benefited us and it has not benefited us. But as someone who has not hanau yet, has not had any royal children to produce of yet, I would like for us to preserve our cultural acts and rights. And I'm in support of all of our midwives here and practitioners that is against this bill. And that's all I have to say.

Thank you. Now, is there anyone on Zoom who I have not called yet who wishes to testify on this measure? If so, please identify yourself.

Hi. I am Melissa Chong. I am in support of HB 1194. I'm a licensed midwife and CPM in Maui. I testify in support of HB 1194. I stand on my written testimony and support Midwives Alliance of Hawaii's amendments. This bill ensures access to the full scope of midwifery care, including gyn services, such as screenings to check for cervical and breast cancer and other concerns. HB 1194 ensures true, informed choice through clarity and accountability. This bill is the only one that protects the safety of birthing people and their babies. Thank you for the opportunity to testify, and I look forward to this licensing program's future success.

Thank you. Anyone else on Zoom wishing to testify? Please proceed.

Aloha. I am reading today and testifying in strong opposition of this bill relating to midwifery. We're in Hawaii.

Oh, please tell us your name.

Oh, my name is Kehaulani Avicolli. Can you hear me?

Yes. Proceed.

I just wanted to say that we're in Hawaii. I hope everyone realizes that first of where you are and where you're profiting off of. We need to support cultural practices and choice of birthing ohana in a place where this was once normalized not too long ago. And when families are empowered and supported, we see healthier desired outcomes, and that is the goal. As a mother, Native Hawaiian, and birth worker in my community for almost 10 years now, I could witness that firsthand. Our midwives wives are highly trained, skilled, and safe in what they do. Many of them are my trusted friends and colleagues that I have the honor to work with. And the PEP pathway and practice needs to be acknowledged. So please vote no on this bill.

Thank you. Anyone else on Zoom wishing to testify? Please proceed.

I would like to testify.

Yes, please tell us who you are.

My name is Jan Ferguson. I am a licensed midwife on the island of Maui. Thank you for the opportunity. I was surprised to learn that I erroneously clicked that I oppose this bill when, in fact, I strongly support it. And I think I've corrected it online. I just wanted to correct it in person with you now.

I stand in support of this bill, and I don't agree with a lot of the testimony that it limits choice. What it's doing is regulating the profession of midwifery and defining midwifery in that regard and not saying that others who do this type of work need to stop. They just aren't going to be licensed midwives.

One does not need to abandon any healing or cultural practices to meet the criteria for midwifery licensure. So two things can be true at once. I keep hearing that if you meet the criteria and become licensed, that you can no longer have your cultural or traditional practices that you bring to your work. And I don't agree with that supposition. I stand by my written testimony, and thank you for the opportunity to testify.

Thank you, Ms. Ferguson. Anyone else on Zoom? Please proceed.

Aloha mai. I am Kristina Mau, and I am from the island of Maui. I am a apprentice of a pale keiki. I strongly oppose this bill. I stand behind Kristie Duarte, Kiʻinani Kaho’ohanohano, and Kiana Rowley and testimony. As this bill, HB 1194, its provisions is an attack on Hawaiian culture and its people. And we should. It's.

I would like to say something about the testimony that we are not trying to put the traditional midwifery into a westernized box. We are not a box. We have our culture. We have our traditions. And because of this, how it's laying out, it should not be. It should not just be one. And this is not just for. I'm going to keep it short. I am a mother of three, and my first is in the hospital, and my last two was in at home. And I had beautiful births. And I would like to really keep the education as a birth worker here on Maui.

I know mothers who are actually terrified to go into the hospital here on Maui and flying to Oahu. I have a friend who's actually gonna give birth next month who is going to Oahu early to leave and abandon her two other kids on Maui just so she could give birth on Oahu. So there is a very lack.

There's a. There's something that's lacking between the westernized midwives and traditional midwives. It's just midwives, and we should all be able to support each other. And we can have our differences, but we have to agree that the person who is birthing is their choice. The person who is going to give birth and push the baby is their choice of where they want to do it and who is in the room. So. Oh my gosh. Sorry.

Thank you. Would you please wrap it up?

Yes. So you challenge us by making us jump through all these loops you have created and to keep us distracted I really feel like. And instead of trying to bring us together. But I really, I challenge everyone in this room to actually, let's sit together, let's have open conversations, and let's have a deeper understanding of how we can continue to help the mother who is birthing. When we show up, like, let's come up with solutions. Let's come together, not just bring each other down. I hear, I hold all the families who have been through trauma and the midwives who have been through trauma. But we can, we can heal together if we are open minded.

We have your testimony. Thank you. Now, anyone else on Zoom wishing to testify, please.

Aloha. My name is Sierra Dew. I was born and raised on Maui and I am a current resident on Oahu. Thank you so much for having me here. I am in opposition to bill 1194. I did have the privilege of having a home birth with my son with the support of a traditionally trained midwife.

This was an extremely, extremely important choice for me. And I believe that every woman should have the choice to be able to decide how they birth. And you know, during birth is an extremely vulnerable place to be in. And oftentimes, you know, in the medical system, there is not a lot of awareness around trauma. There's not a lot of awareness around our bodies and consent.

And so to have someone that is there with you that is solely there for the purpose to make you comfortable, to create a relationship with you, is very, very important. Especially, you know, to create a culturally appropriate experience for women that, you know, that are kanaka, that and people of color to have like their choice of how, of who they have in the room with them is also a really important part of mitigating trauma in the birthing process.

So, yeah, again, I am in opposition of this bill, and I also hope that folks can come together to create something that is really meaningful for all folks and especially centering Kanaka Maoli who this is the place, this is where we are. And so those choices and that should be uplifted more than anything.

Thank you very much. Now there is one more person on Zoom I'm told. Please proceed.

Aloha. My name is Manu. I am based on Oahu. I'm currently a doula and birth worker. I have assisted births in the hospital and at home and have seen the grave difference between both settings. I'm in opposition of bill 1194, and I'm going to keep it short as well.

I just want to say that ancient Hawaiian birthing practices are not just about the physical act of birth. They're about the spiritual connection between the mother, the baby, the land, and the elements. It's a deeply sacred time full of healing, strength, and connection.

These practices, when coming from a traditional midwife, are passed down through generations and guided by intuition, connection to aina, and the support of loved ones. The ability to honor these spiritual and cultural traditions is essential to health and the well being of our families and our current communities. Not allowing traditional midwives to practice only furthers the agenda of really erasing Hawaiian culture and Hawaiian history. And we really, really don't want to do that. Thank you for your time.

Thank you very much. There being no one else on Zoom to testify...

There's one more person.

One more person. I see you. Go ahead.

Aloha. My name is Limona Hassett. I'm from Lahaina. And I just want to say that I oppose this bill, 1194, as its provisions is an attack on the Hawaiian culture and its people. Mahalo.

Oh, thank you so much. Now for sure, no one else on Zoom. One for, one more? Oh, okay. Go ahead.

Aloha. Thank you for your time and the opportunity to share my views today. My name is Jasmine Maes. I'm a licensed midwife and CPM practicing on Kauai for the past five years. And I have been a CPM and practicing midwife for 20 years in three different states. And I have had the experience of working under restrictive law as well as more flexible or broad law. So this process of coming to a workable solution that can serve the community and all kinds of practitioners is fascinating to me.

And I look forward to finding a solution that creates more midwives and better prenatal and birthing postpartum care for our families and is less restrictive. So I'm opposed to House Bill 1194. I'm in support of the alternative House Bill 1328. I am a PEP trained midwife and I did not go to school.

I could not afford to, and I did not want to leave my community to do so. I'm really honored and grateful to be included in Hawaii licensure, and I am pro licensure. I will always desire to hold a license. I do believe that it allows me the freedom to order lab tests, to order ultrasounds, to help my clients file birth certificates. For those clients and community members who are seeking a licensed midwife, great.

If those community members are seeking a traditional midwife, if they are seeking a cultural practitioner, if they are seeking pale keiki, I want them to be able to find it. I do not feel threatened by these practices, and I do not believe that they dilute the safety or the reputation that I hold in my community. Our practices are different, while overlapping, and should be in support of each other. Unfortunately, criminalization does not end unlicensed practice or dangerous practices.

In fact, I believe that it makes practice more dangerous when folks who are not included in licensure laws or cannot qualify for licensure laws avoid safe transfer when necessary because they're afraid of fines or afraid of being prosecuted. Thank you. In the name of safety, and I hope we can come to a solution. Mahalo.

Okay, last call for anyone on Zoom that I missed. No one else. Let us move on to... I'm sorry, we finished calling everyone in person, but I'd like to move on and allow questions from Members to any of the testifiers. Rep Amato, please.

Thank you, Chair. A question for either an OBGYN or perhaps ACLU. Let's go with ACLU, please. Thank you for being here.

Definitely not an OBGYN.

Thank you for being here. My question is, I know you've done a thorough analysis of this legislation. Have you looked at other states and their legislation as well in your analysis of this legislation?

Yes. So as noted previously, 27 of the 30, I think it's 39, 38 states, that allow for midwifery licensure allow for this PEP portfolio apprenticeship pathway. And when you look at the states that have the highest or the best maternal health outcomes, a number of those states allow for the different pathways to midwifery.

Something that's been brought up previously, and I'm sorry, I don't have all the citations in front of me, is that if you look at states and even nationally, the countries and states that have the best outcomes allow for what we call integrating midwifery and what we call western hospital systems. That's the end goal of where we want to be. But we really need to allow for those choices. Recognizing and looking at data because I didn't hear much data being touted today.

I think one testifier mentioned Department of Health, and our own Department of Health said that they weren't concerned about specific outcomes and that it has been meta analysis showing that planned home births actually have less complications in terms of C section. If you look at those outcomes, I think the data needs to be considered in the larger picture.

Thank you. One more quick question. Can the training laid out in 1194, can that be attained here in Hawaii?

No. No, it cannot. It allows for the certified midwife and for the certified professional midwife. But for the CPM, they would have to travel out of state and pursue a schooling. I understand that the amount of schools have shrunk. I think it's down to eight schools. But the PEP pathway, which is apprenticeship pathway, they could do here in Hawaii, but they have to take the exact same exam as the person who completes that midwifery school.

I see. Thank you. Thank you, Chair.

Thank you. Members of Health, any other questions? Rep. Garcia, did you. Okay, proceed.

CPC Committee, any questions? Rep. Ichiyama.

Thank you. For DCCA, Director Ando or her representative.

Thank you so much for being here today. I just wanted to clarify on your testimony. Does the Department take a position on extending the licensure chapter that's about to sunset?

Yes, we do. We clearly support continued licensure of midwives. And so we believe it's important to have something to provide for that continued statutory authority to regulate that. So sunsetting of the previous of the chapter that's currently in place is not an acceptable solution to the situation. We do believe it's important to have continued regulation of midwives.

I did want to note as I and I it's very hard for me to sit there and bite my tongue, but as I'm listening to all this testimony that seemed to be very concerned about how this Bill would bar Native Hawaiian traditional birthing practitioners.

And I don't know if it's the way that the Bill sets it out, but it's specifically, as I understand it, specifically that is protected and not part of the definition of the practice of midwifery under the statute.

I don't know if when people were reading the Bill, they misread it and thought that it meant that was somehow outlawing traditional Native Hawaiian birth practices that are protected under the Constitution.

And so there is a provision, and I kind of want to point that out because I think that this may be where there was some kind of confusion.

Page 24 of the Bill specifically says pursuant to Article 12, Section 7 of the Hawaii State Constitution, practice of midwifery does not include healing practices performed by traditional Hawaiian healers engaged in traditional practices of Palike or other Hanau practices established in existence before November 251892 which may incorporate but are not limited to, and it goes on and on to specifically identify certain Hawaiian practices.

These are practices that are intended to assist pregnant people during pregnancy, birth and the postpartum period. The fact that it states here, it is not part. Those practices are not part of the practice of, of midwifery under the statute.

In other words, that is saying that those are not practices that are going to be regulated by this statutory scheme under this Bill. So I just wanted to point that out because it seemed like there was a misunderstanding.

Thank you for that clarification. I had a couple of follow up questions. In your testimony, you noted some concerns about the peer review section and the data reporting section.

And I wondered if the Department would be open if we deleted subsection D of both of those to give the Department more flexibility to be able to implement those requirements. Is that a alternative?

Yes, it would. That would be helpful.

Okay. And Then last question. You know, I think we've heard a lot of testimony today about the two different approaches between House Bill 1194 and House Bill 1328.

And I was wondering if the Department had taken a position on which path or language it would prefer, understanding that as I tried to clarify, this is our understanding with regard to how those Native Hawaiian practices, birthing practitioners would not be part of what would be regulated under this statute under 1194.

Given that caveat and given the breadth of what was being exempted under 1328, we prefer the approach that set forth under House Bill 1194.

Thank you, Director. Thank you, Chair.

Members of CPC, any other questions?

Thank you, Chair. This is for the Department. Would somebody coming from out of state with certain licensure, he's the expert who went through similar training, have the ability to serve in this, in the midwifery capacity when somebody who's locally went through a similar process?

And I'm imagining there were a lot of references made to having to travel to the continent to get a certain part of this component certificate or license. When those other states allow for not having to do that part, would their license be, would they be able to get hired without that component? And I'm sorry if I'm.

Do you know what I'm saying?

Is it so if I can, I'll try to offer a little bit of explanation on how the licensure scheme works and maybe that will help clarify a bit.

So currently to become licensed as a midwife here, you need to be certified by a credentialing organization and that differs depending on whether you're applying to be a certified professional midwife or whether you're applying to be a certified midwife. So that's the main mechanism that we use to determine whether or not a midwife can be licensed here.

Some of what was discussed regarding the PEP pathway, For example, the North American Registry of Midwives, which is the body that credentials certified professional midwives, they've instated multiple ways to get credentialed by their organization. I don't know if that answered your question.

Yes, and so there. May I Chair? Continue. Do you have a follow up question? Yeah, I mean, please make sure that we're on the same page. Thank you.

So, so there could be states that allow for a different pathway that Hawaii is seeking, but we're not getting offered that alternative pathway so somebody can come from another state and be licensed here. But the Hawaii person, because there isn't more pathways. I guess my concern is are we disadvantaged?

Disadvantaging our Hawaii, you know, the apprentices and the people who want to serve as midwives, are we disadvantaging them over other people's pathways to practice in Hawaii?

Right. So just as a. As a factual matter. Right. I think, as you know, the representative from ACLU explained, there are states that do recognize the pet pathway, for example, towards licensure, and our state currently does not. For anyone that was accredited by NARM after 2020.

Okay, thank you, CBC Members. Any other questions?

There being none. Let's move on to the next bill on the agenda, which is House Bill1328. DCCA. You can come back.

Hello, everyone. Alexander Pang, Executive officer for the Department of Commerce and Consumer Affairs Midwives Program. We stand on our written testimony appreciating the intent of the bill and offering comments and are available for questions.

Thank you. Thank you. Now we also have testimony from Esther Brown, DCCA, offering comments as well. Department of Health on Zoom. Please proceed.

Good afternoon. The Department stands on its testimony providing comments and a proposed amendment. I'll be here to answer any questions. Thank you.

If you could quickly describe your amendment. We do have. We have it in written form, but you might want to just go ahead and describe the amendment.

Yes. Chair. zero, also sorry. I'm Matt Shim from the Family Health Services Division. The amendment is really for the task force. With such a large task force, professionals who are working out in the community in a professional capacity. If two or more discuss topics covered in the task force, under the Sunshine Law, they're actually not allowed.

So working with oip, the language in the amendment would allow lesson a quorum to discuss task force items, just part of their regular profession.

Thank you. Thank you very much. Office of Hawaiian Affairs.

Aloha. Good afternoon, Representatives. Lena Alalei on behalf of the Office of Hawaiian Affairs, we'll stand on our written testimony emphasizing that we support this bill and oppose the last bill that was heard, primarily due to our concerns that the last bill unduly burdens Native Hawaiian practitioners.

Given the language of the exemption and the registration and disclosure requirements, and primarily for this reason, we're testifying in support of this bill is the better way to protect Native Hawaiian practices.

Thank you. Hawaii Home Birth Task Force and Collective, Christy Dwart.

Thank you. My name is Christy Dwart. I'm the chair of the Hawaii Home Birth Task Force and the president of the Hawaii Home Birth Collective. I wanted to share a quick visual of the licensure pathway that we were recently just talking about that is recognized in HB 1328.

So basically, what's currently recognized in our law is you go to a college and you take an exam and then you are given this certificate. The certificate then goes to the DCCA to be able to get a license.

The pathway that we are recognizing that is nationally recognized in 70% of states that do licensure, they follow an apprenticeship pathway which is very extensive. There's tons of skills and education and everything that they have to pass. They take the same exam as our. Our college accredited educated midwife.

Take the same exam, get the same exact certificate, same exact. There's no difference. And this is recognized in 70% of our states. And why is this important? Because 0 of our 41 licensed midwives are Kanaka Maoli. 0 and 1 is born and raised here. Piilani was here. She.

She's trying to get a license and she cannot because this certificate, which is the same as this certificate, is not recognized. So we're asking to please include this nationally recognized pathway. Thank you. Can I close, please? In closing, in regards to delegation of unlicensed personnel, that is in our nursing statute.

So let's give the midwives that ability to also do that. Thank you.

Thank you. Violet Aarona.

Aloha. My name is Violet Napoleilima Kapoheali Okumamalu Moanaliha Aarona, and I am here today in support of Bill HB 1328, expanding access to midwifery and maternal health. This bill provides clear and effective solutions to Act 32 stated in 2019. It covers all birthing practitioners, clinical and traditional.

It provides actual coverage for Native Hawaiians and customary practices under the Constitution, which other bills in the session do not. Not Bill HB 1328 was worked on collectively for years with the hearts and hands of many from traditional midwives to licensed midwives, CPMs, CNMs culture, practitioners, NARM and so many more.

That includes all types of midwives allows them to practice to the full extent of their scopes. Education and training opens up pathways for aspiring midwives such as myself that are actually accessible and comfortable to me.

The only pathway now is the Meek online pathway that is not accessible here in Hawaii and is claimed to be the only accredited and safe course. But most of the casualties here are made by outsiders who come here, mess up, and leave my people to suffer repercussions.

This Bill returns the PEP pathway, an apprenticeship program that takes the same exact test as Meek Pathway students. So you are held to a standard and you are held accountable by community, which is how it should be. An apprenticeship model is not only a way for me to stay home. But it is customary where I'm from.

Makahana ka Ike Oiaka Ha'avina'ana Kupuna. That is the teaching of our kupuna. The best way to retain knowledge is in the doing, in community and conversation. That is the way of my people. We have been in maternal crisis for far too long.

We must give our practitioners back their freedom to practice as they've done so for years and those before them have done since the beginning of. We must give back the choice and care these families deserve. We cannot continue to put our people in distress. You promised to speak for us, to stand with us and protect us.

So please do so and support Bill 1328. Mahalo.

Thank you very much. Charlene Rowley.

Yes, hello. My first name is Charlene Kiana Rowley. I am the board President of Pacific Birth Collective. And I stand here today on behalf of our board of directors. And I want to just expand on our testimony from earlier and say that we support HB 1328 and we oppose Bill 1194.

And there's two points we stand on our written testimony that I just want to highlight.

One of those points is that the work that's gone into 1328 with the national accrediting bodies for these two credentials, which we are talking about regulating through ACNM for the Certified midwife, there has been a lot of conversation and hard work that have gone in through the Hawaii chapter of ACNM and going back and forth to national reviewing the language in this Bill.

Language is very important and the affiliation with the national organization is important that we get it right, as well as with NACPM, which is the national organization which regulates the certified Professional midwife. And they have testified in support of this bill.

And the third piece that I just want to say is, in terms of safety, expanding on what I was talking about earlier in terms of the data is that EMS data is available through the Department of Health saying that Hawaii home birth outcomes for the last 10 years is under 6%, 95% of the home birth outcomes are safe.

And it's in line with the national standards of what we see for home birth outcomes, even with the exemptions. So the horror stories that you're hearing and the power differential that exists between the medical establishment and out of hospital independent practitioners is a very small percentage of numbers.

And we know that trauma is also happening in the hospital. So putting these practitioners who are trying to get access to licensure at a disadvantage from mainland providers is unconstitutional. Thank you. And we need we support this bill? Thank you so much.

Thank you. American College of Nurse Midwives, Hawaii affiliate Not present. Okay, let's. Alana Koa.

Aloha again. My name is Alana Koa and I am in support of HB 1328. Like I said earlier, I come from the island of Maui. I am a mother myself. I'm a member of Hawaii Home Birth Collective, and I'm a Homaana apprenticing under Malama Napua Ohomea, an inspired midwife.

The reason we ask and need your support on this bill, HB 1328, and not the other bills being proposed is because our bill covers, respects reproductive choice and protects everyone, including licensed midwives, traditional midwives, CPMs, CNMs, cultural practitioners, religious beliefs, and me. This Bill protects me as a Kanaka. As a Kanaka, this Bill protects our cultural rights.

It protects the practice of hanau, a practice that is as old as time. Hanau is the practice of everyone's existence here in this room, in the world. This Bill lets us. Lets me be able to learn from my kupuna, learn from my aunties, my uncles.

As of right now, it criminalizes my tutuahine, my grandmother, to offer care or knowledge to me about pregnancy or even to be at my birth, which is crazy to think that would criminalize a tutuahine. Our Bill helps protect the safety of women's human rights and maternal health.

So women have the right to choose where and how and whom she wants at her birth. Birth is a cultural practice. It is a ceremony. Birth is women. It is in our blood and in our nature.

So all the women and families that fear birth or are uncertain and hold their own traumas, what if we were able to heal all of them from their traumas and give our people the choice of how they want to hanau and give women and families the actual care that they deserve during hanau.

Thank you very much.

I want to add one more for the PEP process because this Bill will bring back the PEP pathway just like people like me that can keep me home and is affordable and I can learn from my people compared to the other Bill that restricts that. So mahalo. Thank so much for your time.

Now, are you testifying? American College of Nurse Midwives, please step forward. I had called your name. Yeah.

Hello again, Aloha. My name is Margaret Reagan and I am secretary of the board of the Hawaii affiliate of the American College of Nurse Midwives. Sitting here, I'm going off page. Sitting here, listening to a lot of the testimony. What I feel is lacking is where we will come together.

It was at great heartache to discover a second bill was introduced when representatives who were aware of the primary bill did not engage in conversation, though we approached them sincerely. Now we are here before legislators who may not well understand the intricacies of midwifery.

I very much appreciated your question regarding is there discrimination against Hawaii based providers compared to outside providers coming in with licenses where they were recognized. I did not hear a clear answer from Mr. Pang.

The truth is there is discrimination and it should be understood that there is not a single pathway to licensing as a midwife in Hawaii, not as a CNM, not as, not as a CM, not as a CPM. It is not available. This bill could change that.

This bill could change the whole potential for Hawaii to grow their own providers who we so desperately need who are culturally relevant and available and potentially affordable if they are properly established through clear licensing laws.

I want to reiterate which you may not have understood in my background as a certified midwife, I went to school as a holder of a Bachelor's of Arts. I entered a Mastery of Science program in midwifery as a non nurse student. I graduated.

Thank you. With the same. Thank you very much.

Please conclude in closing what to say. You all hold so much power and I hold you to educating yourself about the intricacies because we are near now held helpless for decisions that will reflect the future.

Thank you. Thank you very much. On Zoom we have Nadine Ortega not present. Leah Minton, please proceed.

And Committee Members of Health and Consumer Protection and Commerce. My name is Leah Minton. I'm the Board President of Midwives Alliance of Hawaii and I'm a certified nurse midwife. We thank you for this opportunity to testify in opposition to HB 1328.

We cannot support HB 1328 as it does not require mandatory licensure for the midwifery profession which by Hawaii regulatory law shall be retained. Data out of Oregon demonstrated that unlicensed providers attending community birth had infants who died at 400% higher rates than licensed midwives attending community birth.

Yet the infant death rates of licensed midwives practicing in the community was similar to that was similar to the infant mortality rate with licensed providers in the hospital. We believe that this shows that licensure that is mandatory does matter.

Additionally, HB 1328 does not meet the national and international educational standards for midwives and 13 out of 20 states that have licensed certified professional midwives since MEEC accredited schools became available in 2002.

Sorry, 13 of those have and a total of 22 out of 38 states do require accredited education or additional education beyond a non accredited apprenticeship pathway. 50% of the midwifery schools are available through online curriculum with the hands on portion of their schooling to be completed here in Hawaii.

Meaning aspiring midwives can complete their education while here in Hawaii. Requiring NEIEC accredited education does not remove the knowledge that lives here in Hawaii. It combines that with the national standardized midwifery education to ensure that specific education is obtained.

The apprenticeship pathway is not accredited and does not have specific curriculum for the safety and wellness of our families, mothers and their keiki. We need to ensure midwives have received the minimum standards of education and training for midwives and we have provided written testimony. We ask that you vote no on HB 1328.

Mahalo. Thank you. Thank you very much. Also on Zoom, Lauleva, Iono, not present Austin Shiloh Martin Libertarian Party. Aloha.

Thank you for the time. I'm the Chairman of the Libertarian Party of Hawaii and I stand on my written testimony. I also also want to add a few more words. If we vote no on these bills and stop trying to assert government control over midwifery, then the clause will sunset.

And the only problem then that we would have to deal with is the abuse of existing policy in order to criminalize what is actually a constitutional right. Constitutional rights do not need permissions, they do not need licensure. And this is a huge problem that we're even having this conversation about licensing midwives.

And a lot of them, they just want to be able to practice. So the easiest thing may be to deal with the bullies and, you know, try to support the best bill on the floor.

But the truth is, no matter which bill you vote for, you are voting against women's rights at the end of the day, no matter what, we need to be able to allow for people to make their own decisions.

And if we impose any licensure scheme whatsoever, we're going to limit not only the free market, not only the innovations of our people, but women's rights in General to make these decisions for themselves. It's so important we need to reverse course on the way that we think about mitigating every harm preemptively.

The only way to prevent harms is to take away choices from people that may not always be harmful when exercised responsibly. And so we punish the responsible for the hypothetical crimes of the irresponsible.

I think it's really, really important that we not overreact to the emotional bait that would cause us to use government force to intervene in one of the most personal and important rights. And think about it. This is directly tied to the outcome.

If we make a mistake and you guys are not experts on this, you should not be legislating on this. No one should. That's just the fact. And so I just want to encourage each of you to remember that government is kind of a one trick pony.

They can take money from one group of people and give it to another group of people.

Thank you.

There's a reason we have government and it's very important. And this is not the reason not to license every human activity on the planet. Thank you for your testimony on Zoom.

We have Tatum Herrick, Malama Napua, Ohamea not present. Rebecca Botello for the record, Pastor Rebecca Botello, proud Kanaka Maoli and senior leader of Birth Believers Group in support of HB 13281921 over a century ago, my great grandfather, Dr. Chang was the chief attending physician at Queen's Hospital and also a home birth midwife.

My mom followed his legacy and so did I. She's a 50 year birth worker. My 10 year old daughter wants to train with her nana, but she's not going to be able to do that. As it stands, before I was a mom, I was an apprentice veteran doula.

I saw so much hospital trauma that I chose home birth for my four babies. Don't be fooled by doctors who stand up here and want to vilify home birth midwives but refuse to acknowledge their harms that I've seen to my clients for 25 years.

A Doctor at Castle who pulled my client's baby so fiercely that the Doctor she broke the baby's collarbone. Doctor at Kapiolani who pulled the baby so hard and twisted his neck that baby went into immediate respiratory arrest. Dr. A.T.

Kaiser who pushed my client to lie down when she was squatting and caused her bottom half, her girl parts to rip open. Doctors, in 25 years that I have attended home birth and hospital birth, I have seen zero maternal harm and zero infant harm in home birth situations. Zero.

Make no mistake, Western birth care is not superior to traditional midwifery, religious midwifery, cultural midwifery. It is simply different. Please Vote yes on 1328. You are deciding on the future freedoms of my daughter, my nieces, my Hanai family, my future granddaughters.

It expands maternal and infant care and provides for informed consent, protecting the freedoms of moms to choose anyone who they want to attend their birth without governmental interference.

Thank you. Mahala from Maui Medic Healers Hui Kahala not present. Ki'I Ka'ohanohano. Okay.

Sitting there, just contemplating. There's two minutes, and there's so much to share, so much to say, and so hard to get through to folks who don't actually understand who we are. You have your forte. You have your purpose. I was given mine. My purpose is to be a Palikiki.

My purpose is to continue to perpetuate my cultural practices, not just Hanau, but especially Hanau, to make sure that they continue to exist. This is the only bill that will allow me to do that. Sorry, I can't even think. I'm shaking. I'm so upset every time I come to these places.

Contrary to what was stated prior, 1194 will not give us any protections. That's why it was stated so many times. So if you don't understand the bill and you're up here testifying, please get a lawyer.

Unfortunately, I've had to get my own after a decade of trying to relay what is really going on here, not just for cultural practices. And we are not against licensing. We are against making it mandatory for us to fit into boxes, especially when we cannot even access what is being asked of us in order to become licensed.

I could probably pass the narm tomorrow without even studying. But that's besides the point. My cultural practice has already come to the point where it is almost in, like, complete erasure. Non existent. We are reclaiming our practices currently, since 1970s, in my own lifetime. That's my experience. And I could have gotten my CPM potentially.

But you know what? My mentors encouraged me to be who I am. Because the knowledge, the Ike, the experience that I have, not just as a Hanau practitioner of a mother of five, but all of the gifts that I've been granted are so rare already. So should I focus on some mainland education or Westernize my practice?

I should continue to be steadfast, to hold my practices dear, as they are to me and all of those around me.

Thank you very much.

Because if I don't and I decide that I'm just gonna go some western route, guess what? They're gone. It's called colonization. And that's why. Thank you. 1328 calling my uncle. I'm unfinished in one sentence. Promise. Okay. That's why 1328 is the only Bill that we can pass this session. That will be the solutions that we need.

And if not, guess what? Kahoohanohanu versus the state is still on.

Thank you, Pop. Gonna ask audience to please refrain from commenting. We don't do that here, please. Papa Ola Lakahi Kiyopu Rilets Aloha.

Again, chairs, vice chairs, Members of the Committee. My name is Keopu Rilitz, Director of Policy and Strategy for Papa'ola Lokahi. Again, you have our written offering comments. And again, I just want to make very clear that our comments are strictly relating to protecting our traditional Native Hawaiian healers.

That is defined in both federal and state statutes or protected in both federal and state statutes for this bill. If you're considering moving this forward, I think as written, we are. Okay. And we're supportive of the provision relating to exempting Native Hawaiian healers as it is written. But again, here to answer any questions.

And here again, solely on that very narrow focus.

Thank you. Michelle Palmer present on Zoom. Jasmine Mays, please proceed.

Aloha. Again, I'm in support of House Bill 1328, and I wanted to focus on some of the positives. I sat in on sharing about the bill and I was so impressed with all of the research that has been done.

So thank you so much to those who have taken the time to learn about legal language, to learn about how to be inclusive, and to have reached out to my credentialing body to support the practices that for 20 years, things like peer review and continuing education, tracking our outcomes, these things have. The work's been done.

We don't need to rewrite this work. It's already in place in the ways that we practice. As a guest here, I just want to say that this really inspired me that it was a way to honor the practitioners and providers who've come before me in Hawaii. I'm so lucky to be here.

So as a guest and as a PEP trained midwife, I am one of those outsiders. I am one of those people who qualified through the apprenticeship pathway and continue to provide essential and safe care in my community. If it wasn't for that apprenticeship pathway, I wouldn't be here doing this.

We have four active practicing midwives on Kauai, and I regularly take as many as eight clients in a month, which is too many for one person. Not safe. So I look forward to training new midwives through the PEP process.

And I'm also inspired by the work that's been done on extending Medicaid access and limited prescriptive authority to licensed midwives in Hawaii. I feel like so many families approach me and ask how their QUEST benefits can be applied to their health care.

And from the day I got here, I called QUEST Application and said, can you make a box for me to check to become a provider, please? And they said, we don't have a box with your credential on it. And so I would be giving this kind of essential health care if I was allowed to.

So I was really inspired by the way that this law broadens the scope and allows midwives to practice to the full extent of our training. Thank you.

ACLU of Hawaii.

Aloha Chairs. Carrie Ann Shirota, Policy Director for ACLU of Hawaii we strongly support HB 1328. It's a bill that we've actually been working on with community and even lawmakers for literally months trying to find common ground and also emphasizing, again, this comes down to reproductive rights, but also for protections.

We just want to highlight significant points in this bill that it allows for three pathways for licensure, certified midwives and certified professional midwives. The two pathways, the PEP apprenticeship as well as the meek schooling.

We we also have clear and explicit exemptions for Native Hawaiian traditional, customary, healing and birthing practices for religious and cultural for the birth attendant that we not criminalize doulas, lactation specialists and Hanae family.

And just from a statutory construction perspective, speaking as someone as a lawyer who previously worked for the state, the Hawaii Civil Rights Commission, from an enforcement perspective, when you're enforcing the law, it is important to clearly outline exemptions for the enforcement agency. And this specific statute is very clear. You look subsection exemptions that they're put in notice.

On the flip side, the community is put on notice to understand which actions or activities are exempt and which is not. So it's also for the community members all to be on the same page. And this is not only the ACLU of Hawaii's opinion, but this is also the legal opinion of the Center for Reproductive Rights.

I have been in consultation with them as well as Native Hawaiian Legal Corporation. While they're not here today, they submitted testimony in support of HB 1328 and in opposition of the other bill, specifically because in the other bill, I just have to compare and contrast.

It does allow and has language for Native Hawaiian practitioners, but it's not as clear. And it requires practitioners to comply with a whole host of requirements which would unduly regulate the practice. And that was the subject of the litigation.

So part of the reason we're here is that we can work together to pass a statute that will address all these issues and potentially avert the litigation or future litigation on the bill that's forthcoming. Thank you so much.

Laulani Teale, Ho'opae Pono Project. Is she outside? Let's go on. Margaret. Margaret Ragen, you're back.

So one of the reasons why you keep seeing me is I'm the only CM in Hawaii, and so I have to wear all these different hats. I speak, I get to speak with you now as just a midwife who wanted to practice midwifery in Hawaii.

And when I went to the hospital to apply, and where I had come from, I had worked in a hospital. They would not take. The headhunters were happy with my application. They would not take my application because I had my and I keep talking about it, the equivalence had not been established in the statute.

And so my only provision was to work outside of the hospital. And that was largely because the bill, like the vision of the bill, was for community birth.

And I think I want to I hope we can bring back the conversation that this is a comprehensive bill, this is a major achievement that we are on the verge of achieving that will take care of licensed midwives, clarification on exemptions, and reproductive, religious and constitutional rights.

And as a member of the board and as the only CM, we worked very closely with ACNM National to establish clear language. So there's very clear language regarding what is a midwife, what is a certified midwife, what is a licensed midwife, what is the practice of certified midwifery, what is the practice of certified professional? They're very clear.

And this is the preferred language by ACNM National where there will not be any questions, they'll be congruence. We have worked with advice from NARM and we've gotten clearance on those equivalent. That equivalent language. And thank you.

You're welcome. Thank you very much. Just in case there are people outside who are waiting to testify, you should know that there are a couple minutes delay between us in here and outside.

So you should step inside if you're waiting to testify because as I said, there are a couple minutes delay, although you won't hear it until a couple minutes. Time warp. Okay. Paul Garcia. Okay. Sierra Dew . Oh, on Zoom, please proceed.

Okay, thanks. Aloha, my name is Sierra Dew. I'm here in strong support of HB 1328. Again, as a mother, I had the privilege of experiencing a home birth with the support of a traditional midwife. And that was very, very important to me and my process. I feel that birth is a very vulnerable experience.

And it's really, really important that people get to choose who they birth with. This is a human rights issue. I absolutely believe that it's incredibly important to mitigate trauma. I also have had also experienced going to the doctor as well and trying to speak to them about having a home birth.

And they didn't even want to hear about it. I felt that they constantly were telling me that that was an unsafe choice, that they were making me feel irresponsible. And it honestly felt like bullying.

I do not feel that the medical system and the western medical system is very educated around home birth, that they do not even know about these choices. And I believe that every woman should be provided and educated around the choices that they.

And the fact that this bill comes from the community, that there are many people that have participated in creating this over months and years, midwives, cultural practitioners, lawyers, organizations, and it is very inclusive to allow the practices and the approaches that are going to meet different people's needs is really important as well, there is no evidence that restricting any type of midwives makes anyone safer.

It only will force practices underground, which will actually make everyone more unsafe.

Thank you very much. Thank you. Also on Zoom, we have Christelle Sharkat not present. Pahnelopi in person. Pahnelopi McKenzie.

Again, thank you guys for all your patience. These bills are super important and these lives are super important. So I am in full support of HB 1328 and I ask you to please support this crucial bill. It gives a broad scope of midwifery care and options for safe outcomes for maternal and infant health.

There are indigenous solutions to indigenous physiology and they should be protected equally as a standard of care in all systems for a sustainable future. HB 1328 supports humanity and safe birth options and we see the maternal health crisis and this is limited on a scope of practice and care and dominating models of supremacist systems.

Before 1920, there were thousands of midwives. There were midwives in Hawaii and they were on the continent. Indigenous and black midwives on the continent were criminalized by laws such as the Sheppard Towner Act of 1920. And the act 32 continues this framework and bill 1194 is extremely in the same context of it criminalizing people we have in Hawaii.

Where did the midwives go? That's the question. Where did they go? They went underground. They became criminalized and fearful of a western medical system that is meant to hurt, to discriminate and dismantle actual care systems. So we must support bills such as HB 1328 and the fact that there's zero, zero, Kanaka Maoli CPMs like this is alarming.

Why is this? We must look at this. And this bill has been written by so many people and the PEP process. So a midwife that can learn in Japan, can learn in New Zealand, can learn in Ghana from midwives that know so many things, they can bring that they can teach.

And then we can have people take tests that are at American standard and pass. So we're saying that we discredit global brilliance when we disclude the PEP process from a midwifery access point here in Hawaii and that we don't actually have access here. We don't actually have preceptors that are willing or can take these midwives.

So we actually dismantle midwifery access by not allowing the PEP process. So HB 1328 does allow true collaborative care. It supports Medicaid reimbursements. And the horror, the horrible statistics have to change. We are in the most dangerous industrialized nation to give birth in like this is a fact.

And we've got to change it, so please support HB 1328. Thank you so much.

Rachel Schrimpf.

Aloha. Again, my name is Rachel Cornell Strumpf, again the first licensed midwife under 457J. I'm a member of the Midwife Committee for the DCCA.

I sit on NARM's Complaints and Grievances Committee as well as HIHBC, the Hawaii Home Birth Collective Elders Council, where we oversee complaints and grievances within the state for all birth workers, licensed or not, doulas, et cetera. I want to speak to a couple things. Washington state in 1920, or, excuse me, how old I am in 2022.

Allowed prescriptive rights, limited prescriptive rights for the CPM. And I'm here really to advocate for that. I want to give an example of rhogam. If a mother has a negative blood type, it's recommended that she gets a dose of Rhogam around 28 weeks in pregnancy and again within three days of birth. This costs about $300 per shot.

Currently, any mother, whether they have insurance or not, has to pay for it out of POC because we do not have the ability to bill their insurance.

I can obtain it, I can administer it to her, but I'm not allowed to call it into the pharmacy so that her insurance will provide it, even though it's a very allowable coverage through insurance. The other thing is, like if a woman has a yeast infection, we recommend a seven day yeast cream.

The way the law is written, I'm allowed to provide her with the cream, but I'm supposed to administer it. And so it's kind of awkward. Do I show up for bed every night for seven days and put it in her nani?

Like that's, you know, like this just kind of clarifies we're not asking for prescriptive rights for anything that's not within the scope of midwifery. But what we're allowing, we're asking you to allow us to utilize our women's health care insurance to pay for things that are completely allowable and within the scope, including contraceptives.

Currently, the way it is, we are not even allowed to provide contraceptives to women, hormonal or not, even though we're allowed to do family and reproductive health care. So. And I have some stuff for you on that. The other thing is back to the pet process. I am a pet midwife.

More than 50% of all midwives that are certified professional midwives went through the PEP process. We do not not have criteria, as was testified earlier by Ma. We have a very extensive thing that you can all look up, go to The North American Registry of Midwives.

Look at the pet process application and see the hundreds of pages that we have to fill out where we have to know every single skill that we have signed off by our teacher, our preceptors, and the preceptors are here in the state, but our hands are tied because currently the exemptions don't cover our students. Thank you.

Our students have to be in a meek program, and that does not allow for the pet midwives. Thank you.

On Zoom, we have Manuela Arango. Please proceed. Manuela Arango. Okay. Ohia Midwifery Wellness. zero, welcome back.

I. I offer myself to answer any questions, and I'd actually really like a question.

Thank you. zero, I'm sorry. Was that.

No, it's super sincere. I have two minutes.

Well, when we finish the testimony. So no questions happen at this time right now.

Okay, wonderful. So I'd like to pose the question to you all. So there are clearly two bills before you. And my practice currently can only rely on cash pay. I cannot obtain insurance, and that is based in statute principles. I would love to serve my community. Anyone? I would adjust with lower Medicaid reimbursement rates as well.

That is what the majority of community birth providers do. And I do have to. I'm realizing I need to honor all of the traditional providers in the room. I've had beautiful conversations with them. They do not operate on a money basis. It is something deeply rooted in their DNA.

I feel very much the same way, and yet it is different. But I'm speaking to the profession, and we do need to have the statutes very clear for a profession. If you are choosing to regulate a profession for the benefit of public safety, you have to allow access to that care that you are regulating here.

I am barely staying in business. I'm opening a clinic. We also don't know if you all can come to a harmonious agreement that will result in a good outcome so that I don't actually have to stop working July 1st.

We have a number of clients who are pregnant, and it takes a while to complete that process as a client. And so what are we telling our clients?

Thank you. Thank you very much. We will get to questions soon as we hear from all the testifiers. Okay. Kehaulani Avecoli on Zoom. Please proceed.

Aloha and mahalo for your time and consideration. My name is Kehaulani Abakoli, a mother, native Hawaiian, and birth worker in my community for almost 10 years now. I'm in strong support of this bill.

HB 1328 we are in Hawaii so I'd expect those that are representing us in Hawaii will be interested in our own cultural practices, knowledge and needs. As continuously stated. Hearing the fact that there are zero Kanaka Maoli licensed here should be a huge concern for everyone. Has anyone ever thought why and how can we support the matter?

Comparing us to other states and standards in America is where so many of you have gone wrong from the start. Hearing from foreigners who are not from this land sharing how they had the privilege to certify this or that way is truly frustrating.

If you are so entitled to think your way is the only way, maybe you should consider practicing and supporting your own homelands. Let's try to consider others so that we can all come to a solution and thrive as a community.

It should be affordable and accessible for our people to perpetuate healthy birthday practices in the way that we see fit, just as the pet pathway entails. I have worked with a lot of these pet professionals and in the hospital and I will tell you that these traditional midwives exceed the expectations and are very skilled and safe.

You can't quite say the same with other certified midwives. Please vote YES for the significant Bill HB 1328. Mahalo.

Thank you. Also on Zoom we have Caitlin Reposar not present. Kelsey Amos, please proceed.

Hi, this is Kelsey Amos testifying. As an individual who has had two home births, I am in support of HB 1328. I especially admire a lot of things about it. I mahalo everyone who worked to develop this Bill. It seems like it was a really intensive and exhaustive and smart effort.

I just want to call out that I really appreciate the home birth task force that it would create. There are really rational, smart reasons for choosing a home birth and I think home births have been on the rise.

If I'm not mistaken, if you want a Low intervention birth, that is a birth where you let the physiological process of birth to unfold. It is more likely that you're going to get that in a home birth than in a hospital situation.

Hospitals are designed for interventions and maybe they should be because that's where you can get interventions. If you want to try to avoid a C section, I think the likelihood of that is higher with a home birth and it is okay to want to pursue this.

Moms will do just about anything for their babies, but they shouldn't have to undergo major abdominal surgery or kind of be pushed in that direction by the provider.

So just to provide some context, these are some of the reasons why people choose home birth and I was very frustrated in choosing my home birth that it was an either or dichotomous situation between these two sides that seem to hate each other. I would like to see communication and collaboration.

And to me, the first step is definitely ending measures that criminalize the cultural birth workers or birth workers who aren't licensed in a particular way, expanding access to that licensure. So PEP makes a lot of sense to me.

That's like a no brainer that we should have more opportunities for more midwives and more service providers because that's what Hawaii needs. The midwifery model of care in Europe is very effective from what I hear. And they just have so many more midwives and that's what we should have too. So, yeah, that's what I wanted to share.

Like we should be working this all out. We should be working together, we should be trying to make this safer instead of arguing with each other about who's endangering who. And HP13 8 takes concrete steps to do that, whereas the other one just makes it more difficult for the people who aren't supported by licensure.

Thank you very much.

It doesn't help at all.

Thanks. Also on Zoom, we have Nara Boone not present in person. Katie Verhey.

Aloha. I'm Katie Morning Stark, also a traditional midwife from Maui. And I like to say that since I practiced in 1981, we were just doing births. And so this bill that has come forth has been a long time with so much hard work from these younger girls in this task force and everybody that's doing what they're doing.

And this is the bill that we want to have passed. This is a bill that's going to help Hawaii. The midwives from long ago are gone. The Ozark midwives, the black midwives, the Native American midwives, the Hawaiian midwives. They got wiped out a long time ago with no direction of where they were protected. And we are.

You're trying to protect midwifery, birth reproduction rights right now for just not for your children, for your grandchildren and your great grandchildren. We've only got the islands. And this bill is the one you really want to look at. This is the one they've worked so hard on. And this is the education that everybody's needing.

And so I don't. It's just. No, it's a no brainer. Just look at this one. Read it. It was hard for me to understand. And I'm a birth girl, I'm a birth worker. But this bill is, it's honest, it's Real and it's there to protect the people. And that's about all I can say.

I'm not that smart, but I am a good midwife and I am a traditional midwife. I love herbs, homeopathy, chiropractor, acupuncture. I love psychology. But I didn't learn from going to school. I learned being here on the islands and I learned from my own family who had midwives in 1930, from the Ozarks, from the Southwest, from St.

Louis, Missouri. Midwifery was real. It was always there. It was nothing like I thought I couldn't be a midwife. There was no loss that said I couldn't be a midwife. I just wanted to be a midwife.

It was in me to be a midwife, just like it's in these girls or any girl, anybody that's higher advanced than me, the doctors and Mr. Martin here, who knows so much about Hawaii and the culture of what we're trying to say, you guys, we're all in this together. We are arranging rainbow culture.

We are the rainbow people. Come on, you know, Yay for us to be here together. Aloha. Thank you.

On Zoom, we have Adair Ezine Dawson, not prison. Pua O Eli ili, Kelsey Pinto. Aloha.

Okay, thank you. Yeah. Pua O Elele Pinto is my name. And again, a native Hawaiian cultural practitioner around birth. And I support this Bill 1328 because like ACLU and Native Hawaiian Legal Corp, as well as the Center for Reproductive Rights, all lawyers, they have heavily drafted or helped with the assistance of drafting this bill.

And I feel way more protective as a Native Hawaiian cultural practitioner inside this one. I do not feel discriminated against like I did in 11:1124, the previous bill.

And I would please support this bill if we have to choose just one, be the one that is more clarified, more supported by many legal support so that we don't have to keep going back to the courts to fight for legal protection.

And you know, it's interesting that the other bill says that they are in support of Native Hawaiian legal rights. Well, why is that not reflected in the language? And why is it so description size and so the fact that OHA and so many other ones are supportive of this 1328 bill.

Can we please put one that is more clarified and has been more supported by a wide range of organizations and not the other bill that for some reason is spouting organ data that is saying 400% more in death than non licensed providers. That is not accurate. That's not hawai'I data.

And we have been putting forth Hawaii data that does not depict our home birth and are out of licensure practices to be as dangerous as the Oregon data is.

And so thank you for your time and I hope that you can support this bill and to be able to the people that is representing and that we're testifying as native flying practices that we feel protected in a specific bill and not in another bill. So thank you.

Thank you. On zoom, Kerry Kwan. Not present. Jordan Hocker. Not present. Erica Fantop.

Aloha. My name is Erica Fantop. I'm on the island of Maui. I am a student and pursuing currently the apprenticeship program. And I am in strongly support of House Bill 1348. I feel because we have such a variety of midwives that have constructed this bill, it's covering everybody, it takes care of everybody.

And at the end of the day, everybody's focus is on mom and making sure that we have safe and beautiful births and without all excuse my French politics, that bill covers that and creating choice for moms.

They have the right to choose whoever they want and giving us the ability for those of us who want to become midwives to pursue that path, because right now we can't. And yes, there are MIAC schools, but those schools are not cheap, let me say.

And to be able to have the ability to learn, I personally like, I learn on the spot, not through books. Yes, it's good to read the books, but it's actually to put that knowledge into effect makes a world of difference, as you can see is how many midwives that we have that come from the PEP process.

So I am total support of this bill because it gives me the opportunity to serve my community. It gives me the opportunity to stay here and support my community. Thank you.

Thank you. Also on Zoom, we have Christy Kalama. Please proceed.

Aloha. Mahalo. Can you. Let me see. Sorry, one second.

We can see you and hear you.

Yes. Okay, so I am here in full support of HB 1328. So I've just chosen to use my time here today to just mahalo. Mahalo. Our cultural practitioners, birth support supporters, midwives. I'm here to offer my gratitude and my held reverence for all of you and all of your gifts.

Thank you for being members of my community and for caring deeply for your Kuleana, your community. Thank you for your strong spirits, your upright backs, your open hearts, for your deep listening, for your check ins that don't stop after birth. Thank you for your loving presence. Thank you for your blessings. Of protection and support for your community.

Thank you for giving us room to dance in our safe and familiar spaces and for traveling the distance to meet new life with us. May the love of our Creator encircle us. May the light of our Creator hold us. May the power of our Creator care for us. May the life giving power guide us always.

May we all be healthy, happy, strong and free. Yeah. I am so confident and fully satisfied with the care that I received from my midwife and the blessing being a mother that felt the spectrum of care from hospital to home birth.

I'm just so blessed to have felt that after and to just know fully and confidently where the level of care that I'm looking for exists. So mahalo. Mahalo and mahalo Members of the Committee. Aloha.

Thank you. Thank you. Also on Zoom, Daniela not present. Urzi Palko, please proceed.

Hello Members of the House of Representatives. Thank you again. My name is Erg Palko, born and raised on the island of Oahu, currently zooming in from the Big Island. I have a master's in science and I've taught science and performing arts in the state over the past 25 years.

So I'm supportive of House Bill 1138 as far as I understand it. And I appreciate that the languaging has been, as people have expressed today, is such a, such a beautiful partnership between organizations like the American Civil Liberties Union, our only state certified midwife, and cultural practitioners.

All the thought and care that came together to write that is really evident in the languaging. And I also appreciate that it's going to be collecting data I thought we were going to hear today from anyone in opposition to this bill, why, you know, more specific data on why. But I went ahead and I queried CDC data.

I was just curious what's out there. And what I discovered is that there is, there seems to be like a systemic prejudice against anyone who is a non western medical model, certified midwife or certified nurse midwife or whatever.

Because if you actually query CDC data, which they have birth and death outcomes for the entire nation ranked in years is you can, if you query that data, you can select Doctor, Doctor of osteopathy, certified nurse, midwife, certified midwife. And then there is other midwife, which I don't even, which I'm not clear what that is.

And then anyone who doesn't have a midwife title. So cultural practitioners, doulas, people potentially with extensive training and apprenticeship would fall under other, which would also include the person driving your car if you just happen to give birth in the car on the way to the hospital.

So the way the CDC is collecting data, you're not able to actually collect data on people with extensive experience who just aren't in the Western medical model. So I'm worried about any data being presented in opposing this bill.

Thank you.

It's using.

Thank you.

It's using information that was collected in a prejudiced manner. Thank you.

Thank you. zero, I'm sorry. Also on Zoom. Alohi aya, not present. Kai Ana. Not present. Morea Mendoza, please proceed.

I'm here. I'm on zoom. Yep. See you. Okay. Again, I just want to say, because I already got to speak to HB 1194, that I stand in my verbal testimony on that with regards to it being an infringement on my reproductive justice and also on my written testimony that I submitted.

I'll just say briefly, I'm in support of 1328 because it provides a comprehensive and inclusive solution that respects my rights to reproductive freedom by creating pathways to licensure which are attainable to local midwives, not just the ones that could afford the education, not just the ones who have been successfully able to learn online or the ones that had to uproot their families to get their education on the continent, or the ones who aren't even from Hawaii to begin with.

I want to point out that there were multiple licensed midwives who testified today, thank goodness, who indicated that they are pep apprenticeship trained in another state. And then we're able to be licensed in Hawaii based on that training. And yet we don't extend those same courtesies to apprentice trained midwives that are from here. That's discriminatory.

HB 1328 allows me and mothers like me to be in charge of making informed decisions about the safety of our families. And it's so important for the mothers of Hawaii to be able to choose midwives who are also from Hawaii, who are supported in their education towards serving this community. Mahalo.

Thank you. Let's see now. That's all the testimony we have submitted. Anyone here in the audience wishing to testify, please step forward. Please step forward. Please come. Please come up.

Thank you.

Short prescription. This is a guava, very sweet, white guava. The prescription identified is Kukai pa. You eat too much guava, you get stuck. Next thing is what happens when you get stuck in the head. So what do you look for? Hooponopono. Hooponopono is what are the options?

Like the DCCA brought up 25 October, 25 November 1819 to Hawaiian National Usage compared to the kukai pa'a with the apartheid definition of the native Hawaiian. Where can you go? What kind of remedy to have the flow. You can recognize the international treaty obligations. You have that freedom to do that.

It's up to you to take the medicine. So this is a prescription so you can unlock your mind, so you can open up your heart, and we can start having lokahi unity and understanding. Okay. So I think I will cover my stuff. And going back to what was my reservation.

My reservation is with respect to Hawaiian national usage. We can go there. We can do that. It's not every day when you have the opportunity to do that. So clearly when we can bring and preserve each other's life force. And the Hanau. I raised Hanau, my children.

Without study, I wouldn't have been able to take the corn off my daughter's neck when we keep on the road. Or Sierra. Why she went name her child Clay? Because I gave her alai alai to stop the bleeding. So thank you very much. You're supposed to be here. Everybody's wonderful, wonderful testimony. Thank you for coming here.

Anyone else, we can testify. Please step forward. Anyone else be on her? No. Yeah. Okay. Okay, Okay. I know. I see.

Aloha, everyone. Thank you for all being here year after year. Many familiar faces. Really appreciate you guys all taking the time to hear us. I am Jamie Lewis. I am the Executive Director for Hawaii Home Birth Collective. I've worn many hats in this community for over 15 years.

I'm a home birth mother of three who have all been born in my home in Kailua. They were all wonderful, safe births.

I am speaking as the Executive Director today to say that first, I want to give many thanks to the DCCA for recognizing that the birth attendant exemption is something that they would be willing to continue to see as regulation. So thank you. A nod to them.