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Planned home birth concerns in Hawaii

Dr. Lori E. KamemotoLori E. Kamemoto, MD, MPH, Hawaii Section chair

The Hawaii Section received the Improvement in State Legislative Advocacy Award at the Congressional Leadership Conference in March. The award recognizes states who have demonstrated impressive growth in legislative advocacy. The Hawaii Section was honored for its many legislative endeavors, including its efforts to make planned home birth safer in the state.

The Hawaii Section is greatly concerned about planned home birth safety. Multiple neonatal deaths associated with planned home birth have occurred in Hawaii. Several of these neonatal deaths have been associated with the planned home birth of known high-risk pregnancies, such as breech presentation and twin pregnancies. Nationally, when compared to midwife hospital births, planned home births are associated with a four-fold increased risk of neonatal death.

Although planned home births have been performed by certified professional midwives (CPMs) in Hawaii for more than 15 years, there is no licensure, educational requirements, safety regulations and rules, informed consent requirement for patients, or data collection to ensure home birth safety. In addition to CPMs, planned home births are also performed by naturopaths, certified nurse-midwives, cultural practitioners, and others. 

During the 2014 Hawaii legislative session, a home birth safety bill was introduced to address some of these concerns. The bill was heard in the Senate Health Committee and met with opposition by the CPM, naturopath, and cultural practitioner communities. Physicians testified on cases of neonatal death and serious maternal complications that were transferred to the hospital after laboring or delivering at home. The bill was replaced with a task force bill that was not heard in its next committee. 

Local news coverage of the hearing, including newspaper and television coverage, started public education on this issue. A non-scientific poll was conducted soon after the Senate Health Committee hearing by the Honolulu Star-Advertiser on February 11. It asked, “Should midwives be licensed with training and other requirements regulated by a medical board?” Eighty-three percent of respondents answered “yes” (2,225 votes), and 17% answered “no” (458 votes). In speaking with the general public, many are surprised that although their manicurist and hair stylist, for example, are required to have a license and meet minimum educational requirements for safety’s sake, the same is not required of home birth providers.

To avoid preventable deaths or harm, mothers who plan a home birth need to know that it should not be considered for high-risk pregnancies. They should also be aware that the availability of a provider with formal education in obstetrics, ready access to consultation, and safe transport to a hospital are crucial to having a safe and happy birth outcome. We will continue to work on this issue to ensure the safety of all Hawaii's mothers and newborns.