Customary release of placentas demanded

A state rule change barred the traditional practice of home burial

Department of Health officials say they are working to change state rules so that Hawaiians and others can resume the cultural practice of taking placentas home from the hospital to be buried for the newborn's well-being.

For generations, many Hawaiians and people from other ethnic groups had been taking the afterbirth (or 'iewe) home to be buried in the belief that it helps ensure the child's health and well-being. However, more than a decade ago, the practice ran afoul of societal concerns about HIV and other infectious diseases.

The Department of Health was not aware placentas were being released from hospitals until last spring, when a family made a formal inquiry to Kaiser Medical Center to take their baby's placenta, said state Health Director Chiyome Fukino.

"We looked at the rules and discovered, according to the rules, we couldn't give it," she said.

The controversial rules were drafted about 1988 or 1990 because of national concerns about the HIV virus and other blood-borne diseases, Fukino said. They define pathological waste (all human tissues, organs and body parts removed during surgery or autopsy) as infectious waste subject to management and disposal.

It is offensive to Hawaiians to classify the 'iewe as "infectious waste," Vicky Holt Takamine said as Hawaiians and supporters demanded at a press conference yesterday that the rule be changed.

Among those gathered near Queen Liliuokalani's statue at the Capitol were teachers Nohea Stibbard and Kihei Nahale-a of Hilo, the couple that asked Kaiser for their first child's placenta before the birth last July.

Nahale-a said their doctor told them he did not see a problem, then they got a call from Kaiser saying it would not be allowed. "We talked to the Department of Health and got a runaround."

They went to the Native Hawaiian Legal Corp., which filed a federal lawsuit on their behalf before the birth. The court issued a temporary restraining order requiring the hospital to protect the placenta.

Fukino said the Health Department worked with the Native Hawaiian Legal Corp. to change the rules. "We wanted to do it expeditiously." But after the lawsuit, "a lot of our time was spent in court."

The court dismissed the case last fall after Stibbard and Nahale-a had their baby and "the placenta disappeared," Fukino said. But the Native Hawaiian Legal Corp. appealed the dismissal, so the case is back in court, she said.

Stibbard and Nahale-a declined yesterday to say what happened to their child's placenta.

Meanwhile, Fukino said proposed new rules to allow people to take not only placentas, but other body parts, with certain approvals, should be ready within two weeks to schedule public hearings.

"Unless we get a whole lot of protests about the rules, that probably means by early summer we will have it cleared," Fukino said.

Kalehua and Kihapai Krug said they had no problem taking home the placentas from their two oldest children, ages 5 and 3, born at Straub Clinic & Hospital.

However, they were told two days before their third baby was born four months ago at Kaiser that they could not have the placenta, Kihapai Krug said, adding that it is "a severe loss" and "very emotional."

Native Hawaiians believe the 'iewe is sacred because it is an extension of the child and mother and houses their mana.

Author Mary Kawena Pukui wrote that Hawaiians and other ethnic groups "bury the 'iewe deep in the ground because this would keep away devils, so harm would not befall the baby and so the child would not wander," according to Malia Nobrega of the Waikiki Hawaiian Civic Club.

Eunice Ishiki-Kalahele and her husband, Imaikalanai, said they have taken care of the placentas for four children and nine of 10 grandchildren "to re-establish the connection between the mother, baby, ancestors and the aina."

Their daughter was in labor with the last birth at Kapiolani Medical Center when she was given a policy letter that the placenta would not be released, Eunice Ishiki-Kalahele said.

Hawaiians and others are urging passage of legislation -- SB 2133 and HB 2057 -- to allow release of the placenta to the woman from whom it originated if testing shows no findings of infection or hazard.

The bills call for testing the placenta, which the Health Department opposes. It prefers that the mother be tested for blood-borne pathogens before the birth, rather than the placenta.

The department recommends that the bills be deferred so it can follow through with rule changes. Rules still would have to be drafted if one of the bills passed, so the process would not be any faster, Fukino said.

Dr. Marjorie Mau, chairwoman of the University of Hawaii Department of Native Hawaiian Health, and other professors said there are no medical grounds to deny release of placentas.

Families have been traumatized since the rules were applied, Mau said, urging that they be amended to allow a mother to take home the placenta if cleared by a doctor of any potentially infectious agents.