Japanese American Midwives: Culture, Community, and Health Politics, 1880-1950

Conclusion

conclusion Throughout the early twentieth century, Japanese American midwives responded to the health-care needs of their communities. They played a vital role as health-care providers for Issei women, a few Nisei women, and sometimes women of other ethnic backgrounds. Nonetheless, their healthcare work was transformed over time, sometimes by choice and, especially in time of war, by decree. This study began with the question of what the impact of American health politics on Japanese American midwives was. To answer that question required an understanding of how health work was shaped by gender relations, racial politics, international relations, and militarization. When the sanba immigrated to the American mainland, they witnessed tensions in U.S.-Japan relations that affected their lives in the United States and eventually led to war. They encountered an anti-Japanese movement that treated them as a racialized nationality and racial minority. They faced racism in subtle and direct forms, including restrictions on the right to naturalized citizenship, marriage, land ownership, immigration, housing, and hospitals. The American sanba also encountered a health-care environment that was skeptical of the skills and value of midwives. Still, Japanese American midwifery was not eradicated directly by organized medicine, individual doctors, or government regulations. Instead, it remained a distinct healthcare occupation, relatively undisturbed throughout the early twentieth century. On the West Coast, midwives faced relatively little government interference, even though midwife licensing began in the 1910s. Japanese immigrant midwives in Hawai’i saw greater government intervention in their work, but not until the 1930s when the meanings of midwifery were already starting to shift. In addition, licensing laws had little impact on conclusion 186 childbirth practices in rural areas. Government regulations did reach more urban midwives, but even they were not closely or regularly monitored to ensure compliance. Military measures and health policies during World War II, however, had a dramatic effect on Japanese American midwifery and contributed to a decline in midwife-attended births. War, though, was not the only factor shaping midwifery’s future. As the childbirth choices of Nisei women show, health-care consumers also had an influence. In addition, gender relations in the family and the gendered nature of the work affected Japanese American midwifery. The stories of individual midwives in Seattle suggest that Japanese immigrant midwives in urban areas used their midwifery work to carve out autonomy for themselves and escape some of the constraints on Japanese womanhood. In the case of the Seattle sanba, they operated within a social network of midwives and helped to create community among Issei women. This study also examined the question of what Japanese American midwifery reveals about the history of American midwifery. As we have seen, the story of the American sanba reminds us that American midwifery has an even richer multicultural history than scholars previously revealed. It also indicates that midwives were not a monolithic group, even among a single ethnic group. Some Japanese immigrant midwives were traditional midwives, trained by apprenticeship, while many others had graduated from midwife training schools and were steeped in the latest views of modern science. Furthermore, even these urban and rural midwives with similar educational backgrounds in Japan developed very different types of midwifery practices in the U.S. West and Hawai’i, depending on whether they settled in urban and rural areas. Finally, historians sometimes confuse the fact that the number of midwife deliveries declined with the idea that midwives disappeared, but of course they did not. Instead, even as health officials and Japanese Americans redefined midwifery, the American sanba retained a midwife identity, and some, like Toku Shimomura, continued to care for others. This study also illustrates the cultural meanings embedded in health-care approaches. It shows that midwifery was both a cultural practice and a health-care occupation and that the American sanba were cultural workers as well as health-care workers. Like other health-care providers, they operated under a particular set of cultural assumptions, in this case about pregnancy, labor and delivery, and maternal and infant health. The American sanba were products and producers of Issei culture in the process of their caregiving work. They were not only cultural preservers but also agents of cultural change for the Issei and later Nisei. When the Nisei embraced conclusion 187 hospital-based medicine and rejected home-based midwifery, they did so because they saw midwifery not only as unscientific but also as...