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

Author of the award-winning Sick and Tired of Being Sick and Tired: Black Women's Health Activism in America, 1890–1950 (1995), Susan Smith continues her exploration of the history of midwifery and race politics in this thoughtful volume. Japanese American Midwives is a comprehensive review of midwives of Japanese heritage. Smith traces Japanese American midwifery from its origins in Japan to the decline of the practice in the United States. It is an ambitious undertaking, and one that she has completed successfully. She sets forth her thesis in the introduction, seeking to answer such questions as "What was the impact of American health politics on Japanese immigrant midwives?" (p. 3), and conversely, "What does Japanese American midwifery reveal about the history of American midwifery?" (p. 5).

Smith begins by tracing the evolution of the Japanese midwife—from a traditional practitioner, trained by apprenticeship, to the samba, or modern midwife, trained in the clinical setting of professional midwifery schools in Japan. Most of the midwives who immigrated to America were of the latter group. Interweaving the history of race and politics, Smith effectively explains the dynamics and devolution of Japanese American midwifery in the United States. Choosing two communities as case studies in paired chapters, she compares urban Seattle with Hawaii, a rural, less-populated environment. Two critical primary sources form the basis of these chapters: a remarkable fifty-six-year diary by a Seattle Issei midwife (Issei were the first generation to immigrate to the United States), and the personal papers of a nurse who supervised Hawaiian midwives. Major differences are uncovered in individual practice and governmental response. Where Hawaii intervened actively in midwives' practices, mainland practitioners were left largely alone. The impact of World War II on both communities and on midwifery is addressed.

While the trend away from midwives toward physician-assisted birthing began as early as 1900 in the United States, home birthing among the Nisei (children of Issei) diminished with the aging of the Issei midwife population and under the influence, Smith says, of several factors, including assimilation, wartime restrictions and health policies, and concomitant American and Japanese cultural fascination with "science and progress." In the transition to hospitalized births, the samba, who themselves pioneered a scientific approach to birthing, encouraged the Nisei to "seek the best professional care available" (p. 183).

Smith's scholarship is evident in her excellent use of primary and secondary sources in this well-researched volume. One minor quibble: she notes (p. 8) that she conducted twenty-five interviews, but she lists only nineteen in her bibliography. Her extensive use of Toku Shimomura's diary covering much of the period under discussion forms the backbone of her description of midwives' daily life and imparts an enriching cultural subtext; with the partial translation of the diary, Smith has made a valuable resource accessible to future scholars. In this considered analysis, she develops her thesis with passion. However, an alternative explanation to her conclusion that internment camp hospitals were "serving the interests of the medical staff, not the patients" because "some doctors turned camp hospitals into teaching hospitals at the patient's expense," making the birth experience "unpleasant" (p. 179), might be that the facilities became teaching hospitals by necessity. By training the many younger inexperienced physicians, senior staff created a larger pool of professionals to handle the case load and to minister to the needs of the detained population.

Japanese American Midwives is the first book of its kind to address this previously overlooked history, and Smith has made a major contribution both to the history of midwifery and to Japanese American literature. The book will appeal not only to those interested in midwives and Asian American historiography, but also to those who...