Hawaii Revised Statutes Division 2. Business § 457J-15

(a) A midwife shall continually assess the appropriateness of the planned location of birth and shall refer to the American College of Nurse-Midwives Clinical Bulletin Number 61:  Midwifery Provision of Home Birth Services (November 2015), or succeeding document, for guidance, taking into account the health and condition of the midwife's client;  provided that the American College of Nurse-Midwives shall have no legal authority or powers of oversight over the director in the exercise of the director's powers and duties authorized by law.

(b) If the midwife determines that a condition of the midwife's client or clients is outside of the midwife's scope of practice, the midwife shall refer the client or clients to an appropriate health care provider or health care facility, or both, equipped to address the client's health care needs;  provided that the midwife shall collaborate with the client or clients or the client's guardian to document what factors will necessitate a change in birth settings to an emergency setting in response to emerging conditions outside the scope of practice of the midwife.

(c) If the midwife is attending a birth at a location without a physician and an operating room and determines during the midwife's care that the client or clients face imminent morbidity or mortality, the midwife shall activate the 911 system and initiate transfer of care protocols.

(d) If the midwife transfers care of the midwife's client or clients during the intrapartum or immediate postpartum period, the midwife shall provide the receiving provider with, at minimum, the information regarding the midwife's client or clients listed on the transfer form adopted by the department.  The transfer form may include reasons for the transfer, brief relevant clinical history, and planned mode of transport.

(e) If the midwife's client or the midwife's client's guardian declines assistance from appropriate licensed health care providers or the 911 system, the midwife shall continually urge the client or the client's guardian to transfer care to an appropriate licensed health care provider and may continue to provide care to save the life of the client or the newborn;  provided that the midwife shall only perform actions within the midwife's scope of practice.