Native Hawaiian Midwifery On Trial

In June of 2024, hearings concluded in a lawsuit against a 2019 law that established strict guidelines for midwifery care in Hawai’i. The suit challenged restrictions placed on the type of licensure midwives in Hawai’i needed in order to practice.

On July 24, 2024, a Judge’s ruling temporarily allowed for unlicensed Native Hawaiian midwifery. Judge Shirley Kawamura temporarily blocked the state from enforcing a law that required the licensing of practitioners and teachers of traditional Hawaiian midwifery. In the meantime, a lawsuit seeking to overturn the statute was making its way through the courts. In 2019, lawmakers enacted the “midwife licensure law” which addressed an issue that “improper practice of midwifery poses a significant risk of harm to mothers and newborns and may result in death”. Violators faced punishments of up to a year in jail, plus thousands of dollars in criminal and civil fines. 1

A group of women, lead by traditional Hawaiian birth attendants, argued that a wide range of people, including midwives, doulas, lactation consultants and family and friends of new mothers would be subject to penalties and criminal liability. The initial complaints also indicated that the law threatens the plaintiffs’ abilities to serve women who seek traditional Native Hawaiian births. Late on the afternoon of July 24, 2024, Judge Kawamura ruled that the state of Hawai’i was barred from “enforcing, threatening to enforce, or applying any penalties to those who practice, teach, and learn traditional native Hawaiian healing practices of prenatal, maternal and child care.”2

Plaintiffs in the lawsuit had already testified during a four-day hearing in June of 2024, stating that the law forces them to get licensed through costly out-of-state programs that don’t align with Hawaiian culture. Lead plaintiff, Ki’inaniokalani Kaho’ohanohano, testified that a lack of Native Hawaiian midwives when she gave birth in 2003, inspired her to become a midwife, herself.

The Judge’s ruling said that the law constituted a deprivation of Native Hawaiian customary rights, which are protected by the Hawaiian Constitution and “the public interest weighs heavily toward protecting Native Hawaiian customs and traditions that are at risk of extinction”. This dispute is the latest in a long debate whether Hawai’i should regulate the practice of traditional healing arts that date back to before Hawai’i became the 50th state in 1959. At that time, native healing practices in traditional healing arts were banished or severely restricted, lasting for much of the 20th century. In the 1970’s, the Hawaiian indigenous rights movement renewed interest in traditional practices.3

Hawai’i did adopt a system under which “councils”, versed in Native Hawaiian healing, certified traditional practitioners. The current plaintiffs stated that they have attempted to form such councils but have failed. In this case, the judge noted in her ruling that a preliminary injunction is granted until there is a council that can recognize traditional Hawaiian birthing practitioners. However, the judge’s ruling was not intended to block the existing law as it pertains to unlicensed midwives who do not focus on Hawaiian birthing practices. A spokesperson with the Center for Reproductive Rights, which represents the plaintiffs, stated that “it is a gap that this order does not address”.

More reporting on the ruling indicated that the lawsuit was filed by the Center for Reproductive Rights, the Native Hawaiian Legal Corporation, and the law firm Perkins Coie on behalf of nine plaintiffs, including six midwives and student midwives, as well as three women who wish to access care from traditional midwives. The ruling was distinguished in that the law’s threat of prison time and fines for traditional Hawaiian midwives practicing prenatal, maternal, and child care was eliminated but does not block other parts of the original Hawaiian Restriction Law, meaning that some midwives who trained through other pathways still faced penalties for serving their communities.

The court’s decision reaffirmed the State’s constitutional duties to protect Native Hawaiian cultural practices and to ensure that they are not regulated out of existence. “For now, cultural practitioners may continue serving the pregnant and birthing members of their community without fear of criminalization or civil fines ensuring that the transmission of this specialized ‘ike (knowledge) is not lost.4

When the Midwifery Restriction Law (the one including money penalties and threats of prison) was first enacted in the summer of 2023, it penalized anyone providing advice, information, or care during pregnancy, birth, and postpartum who does not have a specific state license. There are no education programs in Hawai’i that meet the law’s requirements, meaning that already trained traditional midwives would have to travel thousands of miles to be re-educated through western programs that are expensive and inaccessible to many. Further, the law erases the time-honored apprenticeship model utilized by native Hawaiians and midwives.

Although the complaint filed in Kaho’ohanohano v. State of Hawaii resulted in a preliminary injunction against certain provisions of the state’s Midwife Restriction Law, the case is not set for trial until January of 2026. The Court’s order recognized that the law provided no viable pathway for Native Hawaiian practitioners. In the 2025 Hawai’i State legislative session, lawmakers introduced two bills in the House as potential replacements for the 2019 Midwifery Law. Nothing has been voted into law, at the present time.

Unfortunately, the current (2019) law will sunset it June and so far there have been no replacements for regulating all midwifery in Hawai’i. Without new regulations for licensing midwifery, in general, the entire midwifery industry will become deregulated, back to how it was in Hawai’i before the restrictive 2019 law was first enacted. There are current debates on the importance of setting clear legal standards on who can perform midwifery services. There is a sense of urgency to pass a new law, replacing the old one. According to the ACLU, it is an opportunity to address some of the shortcomings in the current law, and there needs to be clear protections in the measure for Native Hawaiian healers. One of the ways a new measure could do this is by explicitly saying that Native Hawaiian healing practices are not part of the definition of midwifery services that you need licensing for. 5

1. Judge’s ruling temporarily allows for unlicensed Native Hawaiian midwifery. Associated Press; Jennifer Sinco Lelleher. 7/25/24. https://www.clickondetroit.com/health/2024/07/25/judges-ruling-temporarily-allow-for-unlicensed-native-hawaiian-midwifery/

2. Hawaiian midwifery on trial: What’s at stake in this defining moment for indigenous rights and women’s health. July 26, 2024. RECKON. By Annabel Rocha/ arocha@reckonmedia.com. https://www.cleveland.com/reckon/2024/06/hawaiian-midwifery-on-trial-whats-at-stake-in-this-defeining-moment-for-indigenous-rights-and-womens-he...

3. Court Rules in Favor of Native Hawaiian Midwives, Maui Now, July 24, 2024. https://nativehawaiianlegalcorp.org/court-rules-in-favor-of-native-hawaiian-midwives/

4. Hawaii’s midwifery restrictions spark debate over reproductive autonomy, indigenous rights. HONOLULU(KHON2) – Pilar Herrero, senior staff attorney at the Center for Rerpoductive Rights. . . https://www.khon2.com/top-stories/hawai’is-midwifery-restrictions-spark-debate-over-reproductive-autonomy-indigenous-rights/

5. Midwifery bill tries to balance safety with reproductive autonomy, Hawaiian practices. February 13, 2025. Hawai’i Public Radio/By Ashley Mizuo. https://www.hawaiipublicradio.org/local-news/2025-02-13/lawmakers-midwifery-maternal-safety-reproductive-autonomy-hawaiian-practices

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