As a part of late nineteenth-century Japan's modernizing quest for empire, midwifery was transformed into a new women's profession, and the Issei midwives who moved to the United States ("sanba) served as cultural brokers as well as birth attendants. Arriving on the mainland, the midwives found an emerging welfare state in which the government assumed some responsibility for welfare, including health and midwifery. The history of Japanese American midwifery reveals the dynamic relationship between this welfare state and the history of women and health. The stories of these women, coupled with Susan L. Smith's astute analysis, demonstrates the impossibility of clearly separating domestic policy from foreign policy, public health from racial politics, medical care from women's care giving, and the history of women and health from the context of national and international politics. By setting the history of Japanese American midwives in this larger context, Smith reveals little-known ethnic, racial, and regional aspects of women's history and the history of medicine.