Hawaii Birth Center Administrative Rules Update
Hawaii Birth Center Administrative Rules Update:
As many of you know, there currently are no birth centers in Hawaii due to outdated administrative rules that make it prohibitive to open a Freestanding Birth Facility.
Freestanding Birthing Facilities are regulated under the Department of Health’s (DOH) Office of Healthcare Assurance (OHCA). Currently the Chief of OHCA position is vacant, so the Director of the DOH, Dr. Fink is overseeing any potential updates. Freestanding Birthing Facilities administrative rules were adopted in 1986; we are currently collaborating with many organizations to work towards a comprehensive update to these administrative rules.
The updates to these administrative rules essentially required the licensure of midwives first and foremost, as midwives are the primary provider within birth centers. Education around the need for updates to the administrative rules of freestanding birthing facilities has been an over decades long discussion by MAH with legislators and OHCA, as MAH has continued to note the importance of this issue to expanding the community’s access to midwifery care.
Now that midwives are licensed, MAH, along with other key partners, have continued to move this discussion forward. MAH supports utilizing the American Association of Birth Centers (AABC) National Standards for Birth Centers, and Model Regulations to update the administrative rules for Hawaii’s Freestanding Birthing Facilities. This includes a requirement for all birth centers to be accredited by the Commission for the Accreditation of Birth Centers (CABC). Utilizing the AABC’s model regulations language would ensure that as national standards for birth centers update over time, Hawaii’s birth centers would keep up to date with providing the standard of quality midwifery care in birth centers to our community. This would not require amending the Hawaii administrative rules each time an update occurs nationally. Additionally, accredited birth centers are recognized by the American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM) in their Obstetric Care Consensus: Levels of Maternal Care.
CABC provides “the only published standards which can validate that the birth center practices safe, evidence-based maternity care and avoids inappropriate use of technology”. CABC Accreditation requires birth centers and their staff to have proper training and equipment to provide safe care in emergencies, and to utilize shared-decision making processes. You can read about the CABC Accreditation Indicators here.
All birth centers will require a license to operate in Hawaii, and that is issued and regulated by OHCA. This would not change regardless of what updates occur with the administrative rules.
On July 1, 2024, a meeting with representatives from MAH, Hawaii Affiliate of ACNM (HAA), AABC, ACOG, Healthcare Association of Hawaii (HAH), and the Hawaii State Legislature was convened by the Hawaii Maternal & Infant Health Collaborative (HMIHC). Discussion was centered around specific items that the Director of the Department of Health, Dr. Fink, requested the group to explore. Follow up with Dr. Fink is in process and next steps will be determined based on feedback from the Department of Health.
We will be sure to provide updates here. If you have any questions, please reach out.
Stay tuned!
Brief History of Freestanding Birthing Facilities in Hawaii:
Robin Ramsay, CNM shared that Hilo had a freestanding birthing facility in the late 1980’s/early 1990’s that subsequently closed.
Wahiawa General Hospital had a birth center that was run by Dr William McKenzie as the medical director, and the midwives (CNMs) he employed. It was separate from the hospital but on the same campus in the nursing quarters. It is unclear if it was governed by the Freestanding Birthing Facilities Admin Rules or hospital guidelines as it was technically a part of the hospital organization.
Wahiawa General Hospital stopped OB/GYN services in 2004; the birth center had closed previous to that.