HONOLULU (KHON2) -- In the lush islands of Hawaiʻi, the practice of midwifery holds deep roots in the culture and traditions of the Native Hawaiian and Pacific Islander peoples. For generations, Native Hawaiian midwives, known as “kauka hānai,” have guided families through pregnancy and childbirth and offered care that honors both the body and the spirit. Get Hawaii's latest morning news delivered to your inbox, sign up for News 2 You But in recent years, new state laws have placed significant barriers in the way of these cultural practitioners that have threatened to shut down traditional birth practices and the transmission of intergenerational knowledge. A fierce legal battle is underway to protect the rights of Native Hawaiian, Pacific Islander and other cultural practitioner midwives and to preserve their essential role in the community. One key figure in this fight is Ezinne Dawson, a Licensed Midwife (LM) and Certified Professional Midwife (CPM). Dawson, who has worked for years to provide culturally sensitive care, believes midwifery is more than a profession. She believes it is a way of life. Her advocacy is based on the understanding that midwifery must be culturally appropriate to be truly effective. Dawson's approach is not just about birth; it’s about respecting and honoring traditions passed down for generations. “We’re not just talking about childbirth here,” Dawson explained. “We’re talking about a whole cultural context, the wisdom of our ancestors, the connection to the land and how that influences our understanding of life and birth. When you lose that connection, you lose a lot more than just a birthing practice.” Hawaiʻi’s midwifery restrictions spark debate over reproductive autonomy, indigenous rights Hawaiʻi's midwifery laws, passed in 2019, have placed severe restrictions on practitioners who do not meet state licensing requirements. This has particularly impacted Native Hawaiian and Pacific Islander midwives who often do not possess formal state-issued licenses due to the culturally rooted nature of their practice. In an environment where the state demands regulatory compliance, many of these traditional midwives face criminal charges, imprisonment and fines for continuing their work without the requisite credentials that do not take into account cultural practices and traditions. At the heart of this struggle is Kiʻi Kahoʻohanohano, a Native Hawaiian midwife who has been advocating for her community for years. Kahoʻohanohano, who has dedicated her life to mentoring and supporting women through pregnancy and childbirth, emphasized that these practices are not just about giving birth. They are about protecting a cultural legacy. She spoke about the spiritual importance of her role and how her practice, grounded in Native Hawaiian traditions, is more than just medical care. It’s a vital link to her ancestors and their knowledge. Choice is an empowering option: Midwifery in Hawaiʻi “We believe in taking care of the whole person. It's not just the body. It's the spirit; it's the family,” Kahoʻohanohano said. “What we do is grounded in our culture, in the knowledge passed down from one generation to the next. When you don’t have the freedom to practice, it’s not just about the law. It’s about the loss of our identity.” The impact of these legal restrictions extends far beyond the midwives themselves. The result is a profound loss for families in Hawaiʻi who depend on traditional practices to navigate pregnancy and childbirth. In a state with large Native Hawaiian and Pacific Islander populations and populations in rural areas where traditional "western" healthcare is not easily accessible, this loss has reverberated deeply throughout the community. Many families are left without trusted, culturally aware care providers; and this disruption in service creates a greater gap in maternal health, particularly amongst Pacific Islanders and Native Hawaiians. Kirsha Durante, legal counsel with the Native Hawaiian Legal Corporation, is part of a team fighting to protect these cultural practitioners. Durante has been working tirelessly with organizations like the Center for Reproductive Rights to challenge the state's restrictions and defend the rights of cultural practitioner midwives. The litigation centers on the idea that the state's regulations not only violate the constitutional rights of Native Hawaiians but also create irreparable harm by restricting access to critical care. “The lawsuit is not just about fighting for midwives,” Durante explained. “It’s about defending a community’s right to choose the kind of care that aligns with its values and traditions. What we’re seeing is not just a legal violation; it’s a direct threat to cultural preservation and the ability of families to make decisions based on their beliefs.” Durante’s legal team has highlighted the fact that the loss of these midwifery practices isn’t an abstract problem. It’s happening right now, as practitioners who have served their communities for decades are being shut out of the legal system. They are being criminalized for offering the very care that their community trusts and needs. According to Durante, this is a direct violation of Article 12, Section 7 of the Hawaiʻi State Constitution, which mandates the protection of traditional Hawaiian practices. “We had to bring this case to court because, in practice, the law was not doing what it was meant to do,” Durante said. “It was meant to protect these practices; but instead, it was cutting off access to them and creating more harm than good. We needed to show that there is a real and urgent need for the court to intervene and ensure that these cultural practices are not lost forever.” Durante and the legal team’s hard work culminated in a major victory in 2024 when a judge issued a temporary injunction blocking the enforcement of certain penalties against cultural practitioners. The ruling allowed Native Hawaiian midwives, including other cultures such as Pacific Islander, to resume their work without fear of legal repercussions. For many, this was a huge step forward in protecting cultural autonomy. “The court understood that what was happening was not just a legal issue,” Durante said. “It was a matter of cultural survival. The injunction allows these practices to continue and ensures that cultural knowledge can be passed on to the next generation.” But the battle is far from over. While the injunction temporarily halts the penalties, the law remains in place; and further legal challenges are expected. Dawson, Kahoʻohanohano and Durante all agreed that while the temporary relief is important, the larger fight to protect midwifery in Hawaiʻi is still ongoing. The hope is that lawmakers will now work toward crafting a law that not only regulates midwifery but also respects the cultural and spiritual significance of traditional practices. “The key is finding a balance,” Dawson noted. “We need to ensure that midwifery is safe for everyone, but we also need to protect our cultural practices. There’s a way to do both, but it requires a deep understanding of the traditions and the people involved.” Kahoʻohanohano echoed this sentiment. She stressed the need for collaboration between traditional practitioners and the state. “We’ve been here for centuries, taking care of our families. We are not asking for special treatment; we are asking for recognition, for respect,” she said. “The state needs to understand that we are not separate from this land or this culture. We are a part of it.” The broader implications of this case go beyond Hawaiʻi. It speaks to the larger struggle for indigenous rights and cultural preservation in a society that increasingly values standardization and regulation. The fight for midwifery is part of a larger battle for the rights of indigenous communities to maintain their traditions and practices in the face of governmental control. As the case moves forward, both legal experts and midwifery advocates are calling for more inclusive policies that balance safety and respect for cultural practices. For many in Hawaiʻi, the outcome of this case will set a precedent for how indigenous rights are recognized and protected in the future. “This isn’t just about midwifery,” said Durante. “It’s about whether or not our culture and our people are going to be able to continue practicing what’s been passed down for generations. We are fighting for the right to exist as a people.” For Dawson and Kahoʻohanohano, this fight is personal. Their work is about providing a service and protecting a way of life. And while the road ahead is uncertain, they are determined to ensure that the knowledge of their ancestors is not lost. “Our ancestors fought for us to be here, to practice, to live freely,” Kahoʻohanohano said. “It’s our responsibility to fight for the next generation.” One of the issues the midwives discussed, especially those working within Indigenous communities, is that they often find themselves offering care and guidance during pregnancy and birth without the expectation of receiving money in return. Instead, these cultural practitioners rely on bartering or mutual exchange of services as a way to sustain themselves and their practices. The lack of financial compensation for their invaluable services often reflects the broader systemic issues of how midwifery care is viewed and valued, especially in Indigenous communities. Kahoʻohanohano elaborated on the non-monetary nature of her practice. "We often don't receive monetary compensation for our services," she said. "Instead, we engage in what is a deeply rooted practice of bartering. Families give what they can. Sometimes, it's food. Sometimes, it's a service. Sometimes, it's a token of appreciation that has value within our community." She explained She also explained that, for many Hawaiian practitioners, the exchange is about maintaining the sacredness of birth while fostering community ties. "It's never about profit. It's about providing care in a way that aligns with our values and culture," Kahoʻohanohano continued. Dawson similarly acknowledged that while midwifery is not typically lucrative, it is a practice based on giving and supporting families during one of the most significant times of their lives. "I don’t think many people realize how little we actually make from doing this work. The bartering system helps make it work," Dawson explained. "I often get compensated with what people can afford, and that can range from fresh produce to a place to stay or other services they’re able to offer in return. It’s a practical, yet profound way of meeting the needs of both families and midwives." This form of exchange, however, also reveals a tension. Durante discussed how the state’s rigid midwifery laws and licensing restrictions could further complicate midwives' ability to function without financial support. "The laws have made it harder for these cultural practitioners to thrive," Durante noted. "When midwives can't practice in a way that is financially sustainable, it undermines the entire system. These cultural practitioners are often already financially strained, and these laws cut off many of the pathways they relied upon to support their families. When you add fees for licensure, the financial burden makes it impossible to obtain." The reliance on bartering, rather than financial transactions, serves as an important testament to the deep connection between midwives and their communities. However, it also underscores the need for legal and cultural reforms that can better support these practitioners while preserving their traditional role in Hawaiʻi’s birthing culture. As the legal battle continues, the voices of these midwives and legal experts will remain a powerful force as they advocate for the protection of cultural practices that have been vital to Hawaiʻi’s people for centuries. In the words of Dawson, “We’re here to ensure that our culture survives, that our practices continue. It’s about more than birth; it’s about life itself.” You can click here to find a midwife in your area. Click here to learn more about the women’s fight for reproductive choices. Get news on the go with KHON 2GO, KHON's morning podcast, every morning at 8 In the end, it’s not just about laws. It’s about the right of every individual to decide what’s best for themselves, their families and their future.