Japanese American Midwives: Culture, Community, and Health Politics, 1880–1950 (review)

This book examines both the experiences of Japanese immigrant midwives and the changing meanings of midwifery for Japanese Americans, health care personnel, and government officials in the American West and Hawai'i in the late nineteenth to the mid-twentieth century. As author Susan L. Smith notes, Japanese American midwives have been left out of histories of Japanese Americans, American women, and health care. This first book-length documentation of Japanese American midwives both alters and enriches our understanding of these histories.

Smith begins in Japan with the invention in the late 1800s of the sanba, the modern, licensed midwife, who gradually replaced the toriagebaba, the old, traditional midwife. The Japanese government, in its desire to become an international powerhouse, used the sanba to try to prove its modernity to westerners. The government hoped the sanba would demonstrate that Japan had educated its women and had adopted western scientific medicine. Hundreds of sanba, along with many other Japanese, immigrated to the American West and Hawai'i in the early twentieth century. Highly respected in Japan, the sanba continued to receive respect within Japanese American communities. In the United States, midwives provided Issei, or first-generation Japanese immigrant women, with an important link between their old and new worlds. American government officials generally allowed these midwives to practice in the way they wanted in the West. However, they regulated the work of Japanese American midwives in Hawai'i because the midwives attended more births than in the West and because the government wanted to use midwives to further the desires of the white-dominated plantation economy there. By 1950, Japanese American midwives had generally stopped practicing midwifery. World War II had restricted the midwives' work, and Nisei, or American-born second generation women, like other Americans, saw midwives as outdated.

The story of Japanese American midwives seems as though it might be minor as the number of Japanese American midwives was fairly small. Yet, as Smith shows so well, their story is important because it sheds light on a nexus of the history of Japan, Japanese Americans, the American West, Hawai'i, midwifery, health care, and racial politics. In bringing together strands of history that normally stand apart, the book contributes new insights on each strand. For example, Smith's study of Japanese American midwives expands our knowledge of health care for Japanese Americans interned in government camps during World War II. While the sanba were prohibited from delivering babies, they sometimes provided informal home care that "introduced an emotional dimension that helped make the camps livable." (175)

Smith deftly brings together social and political history when too often they are kept apart. For example, she links the larger political story of imperialism, the plantation system and white attempts at labor control, and Asian immigration to Hawai'i to the microhistory of midwives and public health nurses in Hawai'i. She finds that while government officials in the West were not terribly concerned about regulating midwives, those in Hawai'i were. In Hawai'i, midwives' clients were often plantation workers "where the white elite's desire to secure future agricultural laborers motivated at least some minimal health and welfare provisions." (139)

The book features several different forms of comparative history: midwifery regulation in Washington versus Hawai'i, midwifery and health care in Japan versus the U.S., and the experiences of Japanese American immigrants versus African Americans in health care. These comparisons deepen our knowledge of Japanese American midwives while broadening and complicating our understanding of several cultures and locales. For example, Smith explains the American and Japanese governments' very different responses to midwifery at the turn of the twentieth century. While Japan worked to modernize midwifery, the U.S. tried to eliminate midwives in part due to a belief that ignorant, traditional African American and European immigrant midwives caused America's high maternal and infant mortality rates. Smith also expands our understanding of interracial...