A few midwives seek to uphold Native Hawaiian birth traditions. Would a state law jeopardize them?

HONOLULU– Ki’inaniokalani Kaho’ohanohano longed for a deeper connection with her Native Hawaiian ancestors and culture as she prepared to give birth to her first child at home on Maui’s North Shore in 2003.

But generations of colonialist oppression had eroded many Hawaiian traditions, and it was difficult to find information about how the island’s native people honored pregnancy or childbirth. She also couldn’t find a native Hawaiian midwife.

That experience led Kaho’ohanohono — now a mother of five — to become a Native Hawaiian midwife herself, a role in which for years she helped deliver as many as three babies a month, receiving them in a traditional cloth made of woven bark and spoke holy words. , trembling chants as she welcomed them into the world.

Her quest to preserve the tradition also led her to a courtroom in downtown Honolulu this week, where she and others are trying to block a state law they say jeopardizes their ability to continue serving pregnant women hoping for such customary native Hawaiian births.

“It is very important to be able to have our babies in the places and in the ways of our kupuna, our ancestors,” she testified. “For me, the purpose of what we do is to be able to return home to these places.”

Lawmakers passed a licensing law for midwives in 2019, which found that “the improper practice of obstetrics poses a significant risk of harm to the mother or newborn, and can lead to death.” Violations are punishable by up to one year in prison, plus thousands of dollars in criminal and civil fines.

The measure requires anyone who provides “assessment, monitoring and care” during pregnancy, labor, delivery and during the postpartum period to be licensed. According to the women’s lawsuit, a wide range of people are allegedly involved, including midwives, doulas, lactation consultants and even family and friends of the new mother.

Until last summer, the law provided an exception for “midwives,” allowing Kaho’ohanohano to continue practicing native Hawaiian birth customs. Now that that exception has expired, however, they and others are faced with the licensing requirements — including, they say, costly programs that are only available out of state or online and that do not reflect Hawaiian culture and beliefs.

According to court documents filed by the state, the average cost of an accredited midwifery program in 2022 was $6,200 to $6,900 per year.

Attorneys for the state argued in a lawsuit that the law “undoubtedly serves a compelling interest in protecting pregnant individuals from receiving poor advice from untrained individuals.”

State Deputy Attorney General Isaac Ickes told Judge Shirley Kawamura that the law does not ban Native Hawaiian midwifery or home births, but that requiring a permit reduces the risks of injury or death.

The dispute is the latest in a long history of debate over how and whether Hawaii should regulate the practice of traditional healing arts, dating back to long before the islands became the 50th state in 1959. These arts were banned or severely restricted for much of the 20th century. century, but the Hawaiian indigenous rights movement of the 1970s renewed interest in customary ways.

Hawaii eventually established a system in which boards versed in Native Hawaiian healing certify traditional practitioners, although those suing say their efforts to form such a midwifery board have failed.

Practicing unlicensed midwifery, meanwhile, was banned until 1998 — when, lawmakers say, they inadvertently decriminalized it when they changed regulations for nurse-midwives, something the 2019 law sought to remedy.

The nine plaintiffs include women who pursue traditional births and claim the new licensing requirement violates their rights to privacy and reproductive autonomy under the Hawaiian Constitution. They are represented by the Center for Reproductive Rights and the Native Hawaiian Legal Corporation.

“For pregnant people whose own families may no longer have knowledge of the ceremonial and sacred aspects of birth, a midwife trained in the traditional and customary birth practices of the native Hawaiian people can be an invaluable culturally informed healthcare provider” , the lawsuit said.

When Kaho’ohanohano could not find a native Hawaiian midwife to attend the birth of her first child, she instead turned to a Native American, who was open to incorporating traditional Hawaiian aspects that Kaho’ohanohano had learned from her parents .

She surrounded herself with Hawaiian cultural practitioners who focused on pule, or prayer, and lomilomi, a traditional massage with physical and spiritual elements. It all helped ease her three days of labor, she said. And then, “two pushes and pau” – done – the boy was born.

The births of her five children in various Maui communities, Kaho’ohanohano said, were her “greatest teachers” and she became one of the few midwives knowledgeable about Native Hawaiian birthing practices.

She is believed to be the first person in a century to give birth on her husband’s ancestral land in Kahakuloa, a remote valley in western Maui with mostly native Hawaiians, where her daughter was born in 2015. The community is at least 40 minutes away along winding roads to the island’s only hospital.

Kaho’ohanohono testified about helping low-risk pregnant women and identifying cases where she transferred someone to the hospital, but said she has never experienced an emergency.

The other claimants include midwives she helped train and women she helped give birth. Makalani Franco-Francis testified that she learned from Kaho’ohanohano about customary birth practices, including how to receive a newborn in kapa, or traditional clothing, and cultural protocols for a placenta, including taking it to the ocean or burying it for a connecting newborn to its mother. ancestral lands.

The law stopped her education, Franco-Franciscus said. She testified that she is not interested in resuming her midwifery training through out-of-state programs or online.

“It is not in line with our cultural practices, and it is also a financial obligation,” she said.

The judge heard testimony all week. It is not clear how soon a ruling will be made.


Johnson reported from Seattle.