HONOLULU (KeynoteUSA) — Ki’inaniokalani Kahoʻohanohano longed for a deeper connection to her Native Hawaiian ancestors and culture as she prepared to give birth to her first child at her home on Maui’s north shore in 2003.
But generations of colonialist repression had eroded many Hawaiian traditions, and it was difficult to find information about how the islands’ indigenous people honored pregnancy or childbirth. He also couldn’t find a native Hawaiian midwife.
That experience led Kaho’ohanohano, now a mother of five, to become a Native Hawaiian midwife herself, a role in which she spent years helping deliver up to three babies a month, welcoming them in a traditional cloth made of woven bark. and uttering sacred words. , trembling chants as he welcomed them into the world.
Her quest to preserve the tradition also brought her to a courtroom in downtown Honolulu this week, where she and others seek to block a state law they say jeopardizes their ability to continue serving pregnant women awaiting births. like traditional native Hawaiians.
“Being able to have our babies in the places and customs of our kupuna, our ancestors, is very vital,” she testified. “For me, the objective of what we do is to be able to return birth to these places.”
Lawmakers enacted a midwifery licensing law in 2019, finding that “inappropriate midwifery practice poses a significant risk of harm to the mother or newborn, and can result in death.” Violations are punishable by up to one year in jail, plus thousands of dollars in criminal and civil fines.
The measure requires anyone who provides “evaluation, monitoring and care” during pregnancy, labor, delivery and during the postpartum period to be licensed. The women’s lawsuit says that would include a wide range of people, including midwives, doulas, lactation consultants and even family and friends of the new mother.
Until last summer, the law made an exception for “birth attendants,” allowing Kahoʻohanohano to continue practicing Native Hawaiian birth customs. However, since that exception has since expired, she and others face licensing requirements, which they say include expensive programs that are only available out of state or online and that do not align with Hawaiian culture and beliefs.
In 2022, the average cost of an accredited midwifery program was $6,200 to $6,900 a year, according to court documents filed by the state.
Lawyers for the state argued in a court filing that the law “unquestionably serves a compelling interest in protecting pregnant people from receiving bad advice from untrained people.”
State Deputy Attorney General Isaac Ickes told Judge Shirley Kawamura that the law does not prohibit Native Hawaiian midwifery or home births, but that requiring a license reduces the risks of harm 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 that dates back to long before the islands became the 50th state in 1959. Those arts were either banished or severely restricted during much of the 20th century. century, but the Native Hawaiian rights movement of the 1970s renewed interest in the customs.
Hawaii eventually adopted a system where boards versed in Native Hawaiian healing certify traditional practitioners, although plaintiffs say their efforts to form such a midwifery board have failed.
Meanwhile, practicing midwifery without a license was prohibited until 1998, when, lawmakers say, they inadvertently decriminalized it by changing the regulation of nurse-midwives, something the 2019 law attempted to remedy.
Among the nine plaintiffs are women seeking traditional births and arguing that the new licensing requirement violates their right to privacy and reproductive autonomy under the Hawaii Constitution. They are represented by the Center for Reproductive Rights and the Native Hawaiian Legal Corporation.
“For pregnant people whose own family may no longer have knowledge of the ceremonial and sacred aspects of childbirth, a midwife trained in traditional and customary Native Hawaiian childbirth practices can be an invaluable and culturally informed health care provider. ” the lawsuit states.
When Kahoʻohanohano could not find a Native Hawaiian midwife to attend the birth of her first child, she turned to a Native American, who was open to incorporating traditional Hawaiian aspects that Kahoʻohanohano learned from her elders.
She surrounded herself with practitioners of Hawaiian culture who focused on pule, or prayer, and lomilomi, a traditional massage with physical and spiritual elements. All of this helped ease her three days of labor, she said. And then, “two pushes and pau” – voila – the child was born.
The births of her five children in various communities on Maui, Kahoʻohanohano said, were her “greatest teachers” as she became one of the few midwives who know Native Hawaiian birth practices.
She is believed to be the first person in a century to give birth on her husband’s ancestral lands in Kahakuloa, a remote valley west of Maui inhabited mostly by Native Hawaiians, where her daughter was born in 2015. The community is at least 40 minutes on winding roads. to the only hospital on the island.
Kahoʻohanohano testified about helping low-risk pregnant women and identifying cases in which he transferred someone for hospital care, but said he had never experienced any emergency situations.
Other plaintiffs include midwives he helped train and women he helped during childbirth. Makalani Franco-Francis testified that she learned about customary Kahoʻohanohano birth practices, including how to receive a newborn in kapa, or traditional cloth, and cultural protocols for a placenta, including carrying it to the ocean or burying it to connect the newborn to her ancestral lands.
The law has stopped their education, Franco-Francis said. She testified that she is not interested in resuming her midwifery education through online or out-of-state programs.
“It’s not aligned with our cultural practices and it’s also a financial liability,” he said.
The judge heard testimony during the week. It’s unclear how soon a ruling could come.
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Johnson reported from Seattle.
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