ASSOCIATED PRESS Kalehua Krug, right, and his wife, Kihapai, stood on the beach Friday with their daughter, Leleapao'o, in Waianae. The Krugs are involved in a battle with their hospital, Kaiser Permanente, to release the placenta of their daughter in keeping with a traditional Hawaiian birth ritual.

Hawaiians await bill on access to placenta

As the birth of his third child drew closer and closer this fall, Kalehua Krug and his wife, Kihapai, knew they needed the cooperation of their doctor to perform an important Hawaiian birth ritual.

The Krugs told him they would need to take home their daughter's placenta, the organ that unites a mother and her child and is considered a part of the child in traditional Hawaiian belief.

Under the Krugs' family practice, the placenta is planted in the earth along with a tree that is watched as it grows to better understand psychological and spiritual changes in the child.

But while the Krugs had no problem getting back the placenta, known as "iewe" in Hawaiian, from two previous children born at another hospital, their doctor at Kaiser Permanente hospital refused to release material from the afterbirth, treated as medical waste.

Kalehua Krug said the doctor, whom he did not identify, told them that while he did not personally agree with the state rules, the hospital could not release the placenta. But it agreed to keep the placenta frozen in storage.

With the support of legislators and now the state Health Department, a law allowing the placenta to be released to birth parents in Hawaii appears set to become law. Passed by the Hawaii Legislature, it awaits Gov. Linda Lingle's signature.

Meanwhile, Krug said he feels the life of his daughter, Leleapao'o, is in suspension.

"This is a part of my child in essence being held captive -- kidnapped," he said.

After her birth, Leleapao'o developed a herniated belly button -- the point where she had been connected to the iewe -- which Krug said required him to visit the iewe and make a commitment to it that the family would get it back.

It took about four hours at the hospital to negotiate for access to the placenta for a short ceremony, he said, and a few days later the baby's belly button retracted.

"This comes down to being able to take care of your child in the way that we deem appropriate," said Krug, who trains Hawaiian immersion teachers at the University of Hawaii.

Hawaii's rule dates back to 1990, when AIDS was still an emerging threat and relatively little was known about the disease other than its connection to blood, said state Health Director Chiyome Fukino.

A request by a Hawaiian couple in the spring for the placenta of their child first made the department aware of the conflict between its rules and traditional practice.

The parents asked for their newborn's placenta, also at Kaiser Permanente, and were denied. The Health Department then sent out a memo to all hospitals clarifying that placentas cannot leave the hospital.

"The rules are in place for the health and safety of the public, and unfortunately this was an unforeseen consequence of these rules," Fukino said.

Fukino said that changing the rules without legislation would have taken longer because it would have required a lengthy rule-making process. While Hawaiian tradition is clear, no one can be sure once the placenta leaves the hospital that it will only be benignly buried in the ground, she said.

"You don't know what everyone's going to do with this," said Fukino.

The law would be a first in the United States. There are currently no state laws addressing the cultural need to take placentas from hospitals, according to the National Conference of State Legislatures.

The placenta's importance is not a concept exclusive to Hawaiian culture and is found in Polynesia, Asia, Africa and in Western counterculture.

In multiethnic California, for example, policies over whether to allow the release of the placenta are made by each hospital, said Lea Brooks, a spokeswoman for the state Department of Health Services.

If the Hawaii bill is signed, the Krugs are still uncertain when they would finally be able to take their daughter's iewe from the hospital.

"Really, right now it's just a matter of waiting," Kihapai Krug said from her home in Waianae.