HONOLULU (CN) — A group of midwives and their patients asked a Hawaii judge on Thursday for a preliminary injunction on a state law limiting who is able to perform birth work, arguing that the law criminalizes their work and disrupts cultural birth practices.
The plaintiffs in the class action oppose Hawaii's Midwifery Restriction Law, which was enacted in 2019 and requires anyone providing information, advice or care during pregnancy, birth or after childbirth to hold a state midwifery license. Those who do not have such a license potentially face imprisonment, fines and other legal action.
"Restrictive and discriminatory midwifery laws deny pregnant people knowledge and resources critical to their health and culture, perpetuating harmful legacies of control and coercion," wrote Kiʻinaniokalani Kahoʻohanohano, a Maui-based Native Hawaiian midwife and the lead plaintiff in the class action, in a declaration supporting the injunction.
"The Midwifery Restriction Law follows a long line of legal interference with midwifery traditions and other cultural practices and threatens the fundamental human and constitutional rights of pregnant people, Native Hawaiians, and others," she added.
Nine midwives and Native Hawaiian birth workers continued testifying Thursday in the third meeting of a hearing that began Monday before Oahu Circuit Court Judge Shirley Kawamura, arguing in defense of pregnant people's rights and cultural traditions of midwifery.
The plaintiffs — represented by the Center for Reproductive Rights and the Native Hawaiian Legal Corporation — argue that the law fractures collaborative networks that provide crucial pregnancy care to multi-ethnic communities and that it particularly negatively impacts maternal health in underserved areas.
Mirroring the situation in much of the country, Hawaii is confronting a maternal health crisis, with elevated mortality rates among Native Hawaiians, Pacific Islanders, Black and Indigenous communities. The state lacks sufficient maternal care providers and facilities.
The state has argued that the law is actually necessary for maternal health.
Lea Minton, the board president of the Midwives Alliance of Hawaii, testifying on behalf of the state, said certification is vital in Hawaii, as unregulated certification may lead to unqualified individuals with no credentials or knowledge becoming the sole birth provider, potentially leading to an emergency.
"Around the world, each country decides the scope of practice of what their midwives are,” Minton said Thursday.
The conflict between the parties comes from the language of the law and how it defines a midwife versus indigenous birth workers. Within traditional midwifery itself, the law gives several variations and stipulations, while cultures around the world vary in their description and title for people who give birthing guidance.
Rebekah Botello, a pastor who has been working as a doula and childbirth educator in the community for over 20 years, pointed out in an interview with Courthouse News that there are no freestanding birth centers on Oahu for birth care workers to get certified.
They would have to spend thousands on travel and training in the mainland U.S. to become legally licensed, she said. Certification requires completing a program accredited by the Midwifery Education Accreditation Council or the North American Registry of Midwives, neither of which focuses on Native Hawaiian cultural practices or provides classes in Hawaii.
“I think that any practice in any culture that is unique and valuable to them should be preserved in the way it’s passed down. Without the influence, or better yet, without regulation by outside cultures,” Botello said. “I had never heard the term medical colonialism until I came to this group of highly educated, highly trained, highly passionate people. To think that another culture can dictate what is right or wrong for another culture is a pretty high cost.”
Puaoeleili Pinto, a Native Hawaiian birth worker, defended unlicensed cultural birth practitioners in an interview with Courthouse News.
“We have a high level [of standards] to work in the community ... in Hawaiian culture, you don’t promote you are a certain title, the community gives you that title, and that’s different than going to school for a license,” Pinto said. “Versus when you’re trained in the community, the community gives you that approval, and that definition of safety, your community saying that you're safe is really important."
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