HONOLULU (AP) 鈥� Ki鈥榠naniokalani Kaho驶ohanohano longed for a deeper connection to her Native Hawaiian ancestors and culture as she prepared to give birth to her first child at home on the north shore of Maui in 2003.
But generations of colonialist suppression had eroded many Hawaiian traditions, and it was hard to find information on how the islands' Indigenous people honored pregnancy or childbirth. Nor could she find a Native Hawaiian midwife.
That experience led Kaho驶ohanohano 鈥� now a mother of five 鈥� to become a Native Hawaiian midwife herself, a role in which she spent years helping to deliver as many as three babies a month, receiving them in a traditional cloth made of woven bark and uttering sacred, tremorous chants as she welcomed them into the world.
Her quest to preserve tradition also led her into a downtown Honolulu courtroom this week, where she and others are seeking to block a state law that they say endangers their ability to continue serving pregnant women who hope for such customary Native Hawaiian births.
鈥淭o be able to have our babies in the places and in the ways of our kupuna, our ancestors, is very vital,鈥� she testified. 鈥淭o me, the point of what we do is to be able to return birth home to these places.鈥�
Lawmakers enacted in 2019, finding that the 鈥渋mproper practice of midwifery poses a significant risk of harm to the mother or newborn, and may result in death.鈥� Violations are punishable by up to a year in jail, plus thousands of dollars in criminal and civil fines.
The measure requires anyone who provides 鈥渁ssessment, monitoring, and care鈥� during pregnancy, labor, childbirth 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 provided an exception for 鈥渂irth attendants,鈥� which allowed Kaho驶ohanohano to continue practicing Native Hawaiian birth customs. With that exception now expired, however, she and others face the licensing requirements 鈥� which, they say, include costly programs only available out of state or online that don't 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.
Attorneys for the state argued in a court filing that the law 鈥渦ndoubtedly serves a compelling interest in protecting pregnant persons from receiving ill-advice from untrained individuals.鈥�
State Deputy Attorney General Isaac Ickes told Judge Shirley Kawamura that the law doesn鈥檛 outlaw Native Hawaiian midwifery or homebirths, but that requiring a license reduces the risks of harm or death.
The dispute is the latest in a long history of debate about how and whether Hawaii should regulate the practice of traditional healing arts that dates to well before the islands became the 50th state in 1959. Those arts were banished or severely restricted for much of the 20th century, but the Hawaiian Indigenous rights movement of the 1970s renewed interest in the customary ways.
Hawaii eventually adopted a system where councils versed in Native Hawaiian healing certify traditional practitioners, though those suing say their efforts to form such a council for midwifery have failed.
Practicing midwifery without a license, meanwhile, was banned until 1998 鈥� when, lawmakers say, they inadvertently decriminalized it when they altered the regulation of nurse-midwives, something the 2019 law sought to remedy.
Among the nine plaintiffs are women who seek traditional births and argue that the new licensing requirement violates their right of privacy and reproductive autonomy under Hawaii's Constitution. They are represented by the Center for Reproductive Rights and the Native Hawaiian Legal Corporation.
鈥淔or pregnant people whose own family may no longer hold the knowledge of the ceremonial and sacred aspects of birth, a midwife trained in Native Hawaiian traditional and customary birthing practices can be an invaluable, culturally informed health care provider,鈥� the lawsuit states.
When Kaho驶ohanohano was unable to find a Native Hawaiian midwife to attend the birth of her first child, she turned instead to a Native American one, who was open to incorporating traditional Hawaiian aspects that Kaho驶ohanohano gleaned from her elders.
She surrounded herself with Hawaiian cultural practitioners focusing 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, 鈥渢wo pushes and pau鈥� 鈥� done 鈥� the boy was born.
The births of her five children in various Maui communities, Kaho驶ohanohano said, were her 鈥済reatest teachers鈥� in herself becoming one of the very few midwives who know about Native Hawaiian birthing practices.
She is believed to be the first person in a century to give birth on her husband鈥檚 ancestral lands in Kahakuloa, a remote west Maui valley of mostly Native Hawaiians, where her daughter was born in 2015. The community is at least 40 minutes along winding roads to the island's only hospital.
Kaho驶ohanohano testified about helping low-risk pregnant women and identifying instances where she transferred someone to receive care at the hospital but said she鈥檚 never experienced any emergency situations.
Among the other plaintiffs are midwives she has helped train and women she has aided through birth. Makalani Franco-Francis testified that she learned about customary birth practices from Kaho驶ohanohano, including how to receive a newborn in kapa, or traditional cloth, and cultural protocols for a placenta, including taking it to the ocean or burying it to connect a newborn to its ancestral lands.
The law has halted her education, Franco-Francis said. She testified that she鈥檚 not interested in resuming her midwifery education through out-of-state or online programs.
鈥淚t鈥檚 not in alignment with our cultural practices, and it鈥檚 also a financial obligation,鈥� she said.
The judge heard testimony through the week. It鈥檚 not clear how soon a ruling might come.
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Johnson reported from Seattle.
Jennifer Sinco Kelleher And Gene Johnson, The Associated Press
