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SB2569 May Change the Future of Home Birth

A bill relating to home birth introduced in the current legislative session had mothers, natural healers, midwives and other women in the islands concerned that there may be an end to home birth as they know it. The bill sparking the issue was SB2569, introduced by Hawaii Senator Josh Green, a Big Island ER physician. The bill is one of several this session that many from the natural healing community feel are being proposed to harness more control and enforce regulation over natural healing methods.

According to his website, joshgreen.org, Senator Green received his medical degree in 1997 and completed a residency in Family Medicine. He was named Hawaii Physician of the Year in 2009, and currently serves as the Chairman of the Health Committee.

But Green, who describes himself as left from the center when it comes to Western medicine, says that the bill wasn’t intended to stop home birth. He just wants to up the level of safety for everyone involved.

“It is sacred for mothers to deliver at home. Especially on the outer islands there are people living a natural lifestyle and home birth fits with that. It’s also sacred for traditional OB/GYNs to decrease any possible complications in birth,” said Green.

The original bill would have required home birth providers to be licensed beginning on July 1, 2015. In addition, the bill would have required them to keep records, meet minimum educational and training requirements through a home birth safety board, and be subject to disciplinary action when necessary. Advocates for the bill say that it would make home births, which are currently not regulated in Hawaii, safer for mothers and their babies. However, opponents say they don’t want their rights to a home birth taken away or changed.

An impressive amount of home birth supporters shared passionate testimonies at a hearing regarding the bill at the Hawaii State Capitol in Honolulu on February 10. After the hearing, Green announced that he would heed a Health Committee proposal to drop the original language from the bill and replace it with language that would create a task force to discuss the topic.

“It was an extraordinary discussion, so valuable. I was pleased with the outpour of emotion,” said Green.

According to the first lateral revision of SB2569, the task force will be composed of nineteen members to be appointed by the governor no later than July 1 of this year in consultation with the American College of Obstetricians and Gynecologists, American College of Nurse-Midwives, certified professional midwife associations, lay midwife associations, and traditional cultural practitioners.

The document states that the task force will be composed of three traditional cultural home birth practitioners, three members of the public who have given birth at home, three certified professional midwives, two naturopathic home birth practitioners, three nurse-midwives, three physicians (two obstetricians/gynecologists and one neonatologist), one representative from the Healthcare Association of Hawaii and the director of health, or the director’s designee.

“They will spend a year talking and making recommendations, it’s going to be so valuable and the outcome is definitely worth a year of discussion,” said Green.

Issues to be addressed for recommendations to the legislature include home birth standards of care that will enhance patient safety and interdisciplinary collaboration, standards for assessment of potential complications during home births, definitions of high risk pregnancies, emergency transfer protocol and review of infant mortality and maternal mortality data and patterns in the State of Hawaii, among others.

According to the document, the task force shall convene no less than once a month and include neighbor island representation. A report of its findings and recommendations, including any proposed legislation, will be submitted to the legislature no later than twenty days prior to the convening of the regular session of 2015.

Supporters of the bill cite the safety risks associated with delivering babies outside of a hospital. But home birth advocates say that a right to home birth protects them other risks, risks associated with hospital births. Many women who choose to give birth at home are looking to avoid what is often a cascade of routine medical interventions such as induced labor, cesarean sections, IVs, invasive methods of fetal monitoring and epidurals.

“Hospitals are for sick people. Birth is life and health. It’s a natural process of life and not a medical procedure,” says one Big Island mother who had her first child at Hilo Medical Center and her next two at home. Home birth advocates also note the freedom with other birth related choices when giving birth outside of a hospital, such as such as no pressure from hospital staff to vaccinate or circumcise.

For Green, it’s not about stopping home births or forcing people to choose hospital births. He just wants to see tragedies prevented as much as possible, and notes they happen during hospital births as well as at home. “We care about every baby and child despite cultural differences and different beliefs,” he said.

The Big Island has approximately four CPMs (Certified Professional Midwife) attending home births and four CNMs (Certified Nurse Midwife) attending births in hospital or birth homes. There are also three DEMs (Direct-Entry Midwives) and one naturopathic doctor attending home births, according to Dani Kennedy, Certified Professional Midwife (CPM) and president of the Midwives Alliance of Hawaii.

There are three main hospitals on the Big Island offering maternity care. Kona Community Hospital and Hilo Medical Center, both state hospitals, offer standard OB/GYN services. A popular choice for women seeking a more natural and low intervention hospital birth assisted by midwives is North Hawaii Community Hospital (NHCH), a private hospital located in Waimea. The newest place to give birth on the Big Island is a birth home in Puna called East Hawaii Midwife Service where women can visit for prenatal care, labor and delivery, and postpartum care.

“It’s super important for women to make the right choices for home birth and have the knowledge to choose right person,” he said. “Everyone should have a choice and we don’t want to encroach upon people’s beliefs.”

Our readers asked…

What inspired SB2569? - Joy, Hilo

Josh Green: Statewide there have been several fatalities during home births. Of course, there are fatalities in the hospital too so it’s important to look at the entire spectrum of birthing and that was enough to raise the questions and begin the debate.

Is it your personal belief that a hospital is the safer option for birth? - Mahina, Puna

JG: The numbers do suggest that mortality rate is lower in hospitals births, but it’s up to everyone to choose where they want to have their babies.

How were your children born, at home or in a hospital? - Summer Faria, Mililani

JG: They were born in a hospital, although that’s not relevant. Like I said everyone is entitled to make their own personal choices and I have lots of friends who have had babies born at home and I support that. My personal preference really doesn’t ever calculate into any legislation I pass. It has to do with the people I’m representing and look at the entire health care system for everyone.

Where do you see the biggest faults in home birth? For example, not transferring mothers to the hospital early enough or not identifying risks earlier in the pregnancy? - Patricia, Hilo

JG: Well, for all births and any births the largest risk is not picking up the signs early enough when there’s a complication so if someone’s not trained to detect preeclampsia or hemorrhage, then the risks are significant that there could be a bad outcome for a baby or a mom. Some people who deliver at home have extensive training and others don’t, but if someone doesn’t have the capacity to detect what can be a fatal complication then they are exposing people to extra risk.

Do you hope to see the task force make decisions that would coincide with the goals of the original bill and require licensing of Hawaii midwives? - Allison, Hilo

JG: I’m absolutely comfortable with whatever recommendation the task force makes. When the time comes I’ll review it and see if it makes things safer for moms and babies.