Hawaiʻi expands protections for midwives after court challenge; Maui midwife returns to practice

Kiʻinaniokalani Kahoʻohanohano, who served her Maui community as a traditional midwife for 20 years before rstate laws forced her to stop, can now return to her practice without fear of prison time.

The State of Hawaiʻi has agreed to end a legal challenge, which midwife advocates are hailing as a significant victory that protects Native Hawaiian midwives and reverses laws that threatened traditional birthing practices and severely limited access to skilled midwifery care across the islands.

Kahoʻohanohano, a plaintiff in the case, celebrated the outcome.

“We finally have a way forward to protect and pass down our sacred practices,” she said. “I can continue to serve my community with the compassionate, culturally informed care they deserve.”

End of litigation brings relief for practitioners

In 2024, the Center for Reproductive Rights, the Native Hawaiian Legal Corporation and the law firm Perkins Coie filed the lawsuit challenging the law that went into full effect in July 2023. The law penalized virtually anyone providing pregnancy, birth or postpartum care without a specific state license. This restriction not only threatened midwives with criminal liability but also eliminated traditional and apprenticeship-based training pathways.

This year, House Bill 1194 significantly reformed the regulation of midwifery in Hawaiʻi, primarily by making the licensing framework permanent while removing criminal penalties and protecting Native Hawaiian traditional practices. The measure formally regulates the profession of midwifery for public safety while ensuring access to care and respecting cultural traditions.

The new law explicitly clarifies that the practice of midwifery by unlicensed individuals is not subject to any criminal penalty. Violations of licensure requirements are now civil offenses punishable by fines, removing the threat of imprisonment.

The act explicitly affirms that the “practice of midwifery” does not include Native Hawaiian traditional and customary practices as protected under the state constitution. This provides a legal exemption for traditional practitioners.

The bill was enacted into law, without Gov. Josh Green’s signature.

A joint stipulation filed today by the State of Hawaiʻi and the plaintiffs officially ensures that traditional Native Hawaiian birthing practitioners will not face criminal charges for working without a midwifery license.

“Pregnant people should be able to give birth with whichever skilled provider they choose — whether that be at home with a midwife or in a hospital with a doctor. Repealing these laws is a significant step towards making that a reality in Hawaiʻi,” said Rachana Desai Martin, chief US Program Officer at the Center for Reproductive Rights.

Reclaiming traditions amidst health crisis

While celebrating the ability to practice freely, Kahoʻohanohano emphasized that the fight for maternal health is far from over.

“I have travelled throughout the state and have seen firsthand the maternal health crisis we are in. We will continue to reclaim our traditions so that our families are protected for generations to come,” Kahoʻohanohano stated.

The new measures also expand opportunities for students who can now train locally through traditional and apprenticeship-based pathways, eliminating the need to travel thousands of miles to the US Mainland for Western programs.

“Going through apprenticeship training to become a midwife was life-changing. And now I can build a community of midwives by training more students in culturally affirming, community-based midwifery practices,” said Ezinne Dawson, an Oʻahu-based midwife and plaintiff.

Kirsha Durante, Litigation director at the Native Hawaiian Legal Corp., affirmed that this outcome is a protection of state constitutional rights: “The litigation and legislative outcomes achieved affirm the protection of cultural birthing practices and ensures that Native Hawaiian birthing practitioners can continue serving their communities—free from the threat of criminalization.”

Addressing maternal health disparities

The expansion of midwifery access is a step toward addressing a shortage of maternal health care providers. Pregnant women in rural areas often require long drives—or interisland travel—to reach a hospital. Having access to midwives in these communities makes it possible to get care closer to home.

Data reveals severe health disparities:  than white people. Access to community-based midwives provides crucial, culturally informed care and ensures that the values and traditions of pregnant people are respected, particularly those who may face inequitable treatment or pressure for unnecessary interventions in the conventional hospital system.

While this agreement is a victory for traditional practitioners, financial penalties for practicing without a state license still remain for non-traditional midwives. Advocates say they will continue to work toward shoring up full protections for all midwives in the state.