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Education, support and advocacy for birth and wellness choices across Hawai'i

  • 22 Dec 2023 4:07 PM | PBC Staff (Administrator)

    We recommend interviewing several to find one that is a good fit for you and your family.   Most Midwives work for a flat fee or have a sliding scale and you will likely be paying for your midwife without the assistance of insurance. You will want to make sure they offer the services, attitude, and philosophy you agree with. The ability to honestly express yourself and concerns to your midwife, or any health care professional, is central to being able to make an informed decision concerning your care. Make sure that you choose a midwife who you trust and who will be available when you need them, respect your opinions, values, and listen. The following are some suggestions for finding the best midwife for you.

    • Ask friends and family for a recommendation.
    • Midwives come from a myriad of training and experience backgrounds you should ask what certifications and qualifications she has earned.
    • Check their references.
    • Be sure and ask questions about their fees and services.
    • Write down any specific concerns you have about your pregnancy.
    • Talk about your views on labor.
    • Midwives don’t administer pain medication; ask what techniques they use to help if you are finding it difficult to cope with the intensity of labor.
    • Ask under what circumstances she recommends moving the homebirth into the hospital (this is called a transfer).
    • If a transfer is necessary will she go with you to the hospital and will she stay with you as long as she is needed to act as your advocate ?
    • What routine labs does she perform?
    • Does she prefer that you have dual care, meaning that you maintain a relationship with an OB practice throughout your pregnancy?
    • How many days overdue does she feel comfortable with you going before she suggests you induce?
    • Discuss your birth plan, particularly if it includes a water birth. Some midwives offer birth tubs at an additional fee.
    • What part of the island is she coming from? How long would it take her to get to your home during peak traffic times?
    • Find out her accessibility. How quickly does she typically call clients back? Is she available through email for non-emergency questions?
    • How many births does she typically do in a month and how many other women does she have due around the same time as you?
    • Does she have a backup midwife in case of an emergency?
    • Often midwives have at least one assistant at the labor; if so, you will want to meet these other participants.
    • Even if you are using a midwife for a homebirth, It is recommend you find an OB you and your midwife can consult with during the pregnancy if you so choose.
    • Take a tour of the hospital so that you can feel more comfortable if the need for plan B arises.  

    Acronym Definitions

    *all acronyms represent the education and training of the provider and not their legal status to practice in the state of Hawai'i as a licensed provider

    • CPM—Certified Professional Midwife
    • CNM—Certified Nurse-Midwife
    • DEM—Direct Entry Midwife
    • Doula - a Non medical support person during pregnancy, birth, and postpartum
    • LM—Licensed Midwife
    • LMT—Licensed Massage Therapist
    • Montrice - offers support as a Doula but is also able to perform basic medical care under a primary midwife or doctor
    • ND—Naturopathic Doctor
    • RN—Registered Nurse

  • 22 Dec 2023 4:05 PM | PBC Staff (Administrator)

    We recommend interviewing several doulas to see how you connect. Some questions to considering asking are:

    • What is your birth philosophy?
    • What training have you had?
    • How many births have you attended?
    • Have you worked with my doctor/midwife before?
    • What kinds of suggestions do you typically make at a birth?
    • What do you provide as a part of your services?
    • What do you see your role as during the birth?
    • How do you help include my partner in the birth?
    • Can you provide references?
    • How much are your services?

    Acronym Definitions

    • ALACE—Association of Labor Assistance and Childbirth Educators, Cambridge MA 
    • CD—Certified Doula
    • CBE—Certified Breastfeeding Educator
    • CCHT—Certified Clinical Hypnotherapist
    • CLE—Certified Lactation Educator
    • CNA—Certified Nurses Aid  
    • DONA—Doulas of North America
    • LCCE—Lamaze Certified Childbirth Educator
    • PCD—Certified Postpartum Doula
  • 22 Dec 2023 4:04 PM | PBC Staff (Administrator)

    Baby Blues & Postpartum Depression

    Is the baby moon sliding into the baby blues?

    If you or someone you know is experiencing symptoms of prenatal or postpartum mood or anxiety disorder, know that it is treatable. There is someone in your area who can help you if you are experiencing any of the following: depressed, irritable, exhausted, unlike yourself, sadness, anger, guilt, worry, feelings of inadequacy.  

    The following is not meant to be a diagnostic tool, but rather a way for new mothers and their support persons to recognize their feelings and to be empowered to take action if they need help. 

    Baby Blues

    Wise Woman Saying: 'when the milk starts to flow so do the tears'  

    Common between day 4 and 12 Postpartum.  Around 1 in 4 mothers will experience mood swings  during this important period of recovery and adjustment.  
    • These emotions can feel very intense and are linked directly with having enough nourishment, staying hydrated, adequate rest and support.  A new mother should stay in bed and care for her self and her baby and be relieved of all household chores and additional responsibilities for at least the first two weeks while she recovers and sleeps whenever her baby is sleeping!  Stay "On Baby Time"!
    • Fathers and co-parents or support can help by taking baby after feedings to burp them keep them upright for 20 to 30 minutes after feeding to minimize spit-ups.  Holding baby directly on your chest skin-on-skin is a way to form a strong bond and get them used to your smell and to keep them warm and feeling secure.    

    Postpartum Depression (PPD)

    Can happen anytime from Day 12 to 18 months after birth when a mother gets depleted. 

    • If she is not getting the nourishment or fluids she needs to provide for her nursing baby and herself
    • If she is not getting enough sleep
    • If she feels lonely and does not have enough interaction with friends, peers or loved ones 
    • If she has experiences to much external pressures that make it feel difficult to care for herself and her newborn

    She may  experience feelings of restless, worthlessness, guilt, irritability, depression, excessive crying, no energy, headaches, chest pains, trouble sleeping, weight flux, trouble focusing, decision making, overly worrying about baby, lack of interest in infant, being afraid of hurting baby or self.

    When a woman’s ability to function is affected, she needs to seek help!

      Post Traumatic Stress Disorder

      • Many women are wrongly diagnosed with PPD. Medications for PPD will not work for PTSD.
      • Sometimes giving birth can be a traumatic experience 
      • Signs that a woman may be experiencing PTSD include flashbacks, nightmares, panic attacks, numbed emotions, sleeping difficulties, problems with concentration, irritability or anger.

      Postpartum Psychosis

      • Very serious mental illness.
      • Can happen quickly, often within 3 months of birth.
      • Woman can loose touch with reality, experience auditory hallucinations & delusions, insomnia, feeling agitated and angry, strange feelings and behaviors.
      • Women who have postpartum psychosis require someone else to seek the treatment they need right away!!

      Additional Resources at

    • 22 Dec 2023 4:02 PM | PBC Staff (Administrator)

      Being a new parent can be a challenging transition.  It may start to feel like you're tipping over the edge of what you can handle.  You don't need to do this alone!

      Postpartum Doulas are women who are trained to support new families through the transition of having a new baby.  They are here to help you make a plan and answer your questions!  

    • 22 Dec 2023 4:01 PM | PBC Staff (Administrator)

      A doula is a woman experienced in childbirth and knowledgeable of hospital procedures. Doulas provide continuous physical, emotional, and informational support during labor—from massage to aromatherapy, to continuous reassurance and coping techniques for the mother and her family.   

      A birth doula generally meets with you before the birth to develop a trusting relationship and will be present for your labor. They may provide childbirth education, help you develop a birth plan, and set a number of postpartum visits. Most birth doulas work for a flat fee with a sliding scale. 

    • 22 Dec 2023 3:59 PM | PBC Staff (Administrator)

      A Midwife is a healthcare provider who specializes in caring for women during their pregnancy, labor, birth and throughout their childbearing years for routine care. They are trained to support normal physiologic childbirth as well as to recognize and intervene when things extend beyond the scope of normal. Attending laboring women, they typically carry their own set of tools and tricks to the trade (when interviewing a midwife, ask her what these are).  

      Care by a midwife should be a trusting relationship with a knowledgeable professional who supports your autonomy and empowers you with knowledge to take charge of your own health. It is important to interview and ask questions when choosing your midwifery team. There is a wide variety of experience, education and training variation between Midwifery care providers and it is important to find a provider that resonates and connects with your unique needs.  As in most things, assume nothing and ask lots of questions! 

    • 21 Dec 2023 4:10 PM | PBC Staff (Administrator)

      New to Hawai'i? Looking for the lay of the landscape?

      What better place to start than with the people and culture of this land?

      Brief History of Hawaiʻi

      People are 'called' to Hawaiʻi  for many reasons: Personal, spiritual, healing, work, and family. Whatever your calling, please be respectful of these islands and the host culture, and actively seek mindful ways to engage, learn, and participate. 

      It is essential that both long-time Hawaiʻi residents that are not of Kanaka Maoli descent and malihini - visitors and newcomers to these islands - are aware of this dynamic. Sometimes, newcomers to Hawaiʻi live in a bubble of bliss while ignoring these facts. Newcomers can cause harm through displacement and lack of respect for local traditions, places and practices. But newcomers can choose to engage, learn, understand, be humble, and honor the indigenous people, while also enjoying the beauty of this place. 

      Prior to foreign interference, the Hawaiian nation was one of the most literate and educated in the world, with an internationally-recognized constitutional monarchy.   An armed invasion carried out by white wealthy plantation owners in 1893 lead to the illegal overthrow of the Kingdom of Hawai'i.  English was imposed on public life through schools and government, and much Hawaiian culture was forced underground. To this day, the indigenous people of Hawaiʻi are under-served and under-represented in positions of political and economic power because of colonization, and the effects of large-scale agriculture. This has caused political, cultural, social, and economic disenfranchisement. 

      The indigenous culture and people of Hawai‘i are Kanaka Maoli, also referred to as Native Hawaiian.  Hawaiʻi is an occupied nation which culminated ultimately in the status of “Statehood” outside of the acknowledged legal channels defined by the US constitution and international law.   All of this was done against the will of Hawaiian nationals.   The Western societal construct that was imposed on this culture was and is not the way of these lands, and as a result, Native Hawaiians are inherently disadvantaged trying to survive in a system that was forced upon them. 

      If this is new to you, please watch the film Act of War by Dr. Keanu Sai.  

      This is a very brief overview, and the history of colonialism in Hawaiʻi deserves much more understanding. To aid in this, we have added a few resources at the bottom of this page. These are just the first few stepping stones to further your understanding.

      Birth in Hawaiʻi (click here to view more)

      The westernization of cultural practices is not unique to Hawaiʻi, but we certainly see the effects here. Many of the traditional birthing practices have been replaced, indoctrinated, or wiped out by Western models of health care, education, and standards.

      Despite these challenges, we still have a growing number of Native Hawaiian birth keepers, koʻokua (doulas), advocates, kumu (educators), and pale keiki (midwives) who are nurturing, revitalizing, and bringing back the traditions around pregnancy, birth, and postpartum. They are planting the seeds of change for this generation and for all future generations.

      Cultural Appropriation

      Cultural appropriation is defined as "the adoption or co-opting, usually without acknowledgment, of cultural identity markers associated with or originating in minority communities by people or communities with a relatively privileged status." 

      Cultural appropriation and misappropriation run rampant in Hawaiʻi, specifically with large corporate marketing and tourism campaigns selling the culture of Hawaiʻi to visitors. However, large corporations are not the only ones engaging in cultural appropriation. Individuals and small businesses who are not of Native Hawaiian ancestry sometimes use words, customs, phrases, and practices of Native Hawaiians in their work and business. 

      This can be problematic when viewed in context. After the overthrow, the use of the Hawaiian language was banned in public schools and was quickly replaced by English in public spaces. Many significant cultural practices, such as hula, were lost or went underground. Outside influences created shame around being Hawaiian, and language and customs were diminished, causing immense damage. 

      Since then, there have been waves of Hawaiian cultural renaissance starting in the 1960s and 70s. To this day, the people of Hawaiʻi are revitalizing their culture. Once at the brink of extinction, the language is taught widely in immersion schools around the islands. However, generational trauma still exists, and the traumas of the past are not viewed as distant historical events but run as an undercurrent to modern culture, politics, and society. 

      Using Hawaiian words and practices inappropriately or without the proper education and permission can be inauthentic and exploitative. Please be mindful of using Native Hawaiian words, phrases, and traditions in your business practices and giving credit to lineage and teachers. 

      Resources to Advance your Understanding

      To further your understanding and help Native Hawaiian birth work, please look some of these resources. This is just a stepping stone, so please donʻt stop here! There are many resources, books, and workshops relating to white privilege, cultural appropriation, and supporting BIPOC communities. 

      Act of War - The Overthrow of the Hawaiian Nation - documentary from 1993

      Birth Rights  by Flux Hawaii 

      Healing Across Generations by Maui Nō Ka Oi Magazine 

      Hawaiian Customs and Beliefs Relating to Birth and Infancy by Anthropology Source 

      The Struggle For Hawaiian Sovereignty by Cultural Survival  

    Education, Support, and Advocacy for Birth and Wellness Choices Across Hawai'i

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    Updated 9-1-22

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