Cami Kanoa-Wong, a midwife in training, chose to give birth to all three of her children at home.
The 30-year-old Native Hawaiian mother and doula, or birth attendant to other pregnant women, said the experience was both spiritual and cultural for her and husband, Laiana, who performed a traditional oli, or chant, while she delivered her babies.
"My husband chants when I’m in labor whether I like it or not. We bring elements of our culture (into the birthing process)," she said. "As a Hawaiian, this makes me closer to my ancestors. Birth and death are the most sacred times of our lives."
Legislation proposing to establish a home birth safety board to regulate midwives and providers drew passionate testimony Monday from both sides of the spectrum.
Senate Bill 2569 would require midwives for the first time in Hawaii to be licensed starting next year and meet minimum educational and training requirements. In addition, the measure would limit home births to mothers with low-risk pregnancies and require providers to meet reporting requirements.
"This bill as it reads now would basically criminalize any person who is with a woman giving birth outside the hospital that is not a certified nurse midwife," said Summer Faria, 35, who is training to be a certified professional midwife, a different type of home-birth provider that is not required to go to nursing school or a midwifery program. "Most certified nurse midwives don’t do home births. They’re in the hospitals. We believe that birth is normal. The medical model sees birth as a potential problem."
The bill also would require the home-birth board to investigate complaints and take disciplinary action when necessary.
"I’m young, I’m healthy," said Kanoa-Wong, who also planted her placenta as part of a cultural practice after giving birth. "I don’t really trust hospitals anyway. I was afraid to go into the hospital because I know once I got into the hospital, all my choices are taken away from me. For my birthing experience, I want it to be on my terms. There’s no unnecessary intervention with home birth. They’re not going to give me an unnecessary C-section because the doctor wants to go home at 5 p.m."
America has the fifth-highest C-section rate in world and ranks 37th in maternal mortality and 34th in neonatal mortality, for 2.5 times the cost of any other industrial nation, said Clare Loprinzi, a Kona-based midwife who has practiced for more than 40 years.
"The bill would create a board dominated by medical doctors who do not understand the midwifery model of care. They tell you under what situations you would be allowed to attend home birth," said Loprinzi, who said she was certified through the Midwives Alliance of North America. "I come from a line of traditional midwives. We were born to do this work. We don’t use the drugs and the machines. We view birth as a natural process instead of a medical process."
But Lori Kamemoto, representing the American Congress of Obstetricians and Gynecologists, said Hawaii does not keep track of home birth outcomes, a number of which end up in tragedy.
"We really do need licensure. For each tragic outcome, there are many more near misses, increasing the morbidity and injury to mothers and babies," she said. "Other professionals, such as hairstylists, cosmetologists and others, are required to have formal education and training in their fields and are licensed. However, home-birth providers, who deal with life-and-death medical care, do not have any educational requirements or patient safety rules and regulations."
Senate Health Committee Chairman Josh Green (D, Naalehu-Kailua Kona), who introduced the bill, said he supports home births but would like both sides to focus on safety.
"It is clear that there is common ground that can be achieved between doctors, nurse midwives and lay midwives," he said. "This process may take a year."
Kailua resident Laiana Kanoa-Wong, 28, was a "little apprehensive" when his wife, Cami, chose to give birth at home to Haaipo, 7, Kealohaaina, 5, and Puamana, 10 months.
"It is so ingrained in your mind that you go to a hospital and have a baby. It’s in the movies, you see your family do it, it’s normalized," he said. "We’ve been having home births for thousands of generations. Our ancestors were doing it for years. All of a sudden after two or three generations of home births, there’s a stigma to it. Am I saying this is for everybody? No. This is a process that the families should be able to decide. To give birth is a natural thing."
