In the late nineteenth century, midwifery was transformed into a new woman's profession as part of Japan's modernizing quest for empire. With the rise of Japanese immigration to the United States, Japanese midwives (sanba) served as cultural brokers as well as birth attendants for Issei women. They actively participated in the creation of Japanese American community and culture as preservers of Japanese birthing customs and agents of cultural change.    The history of Japanese American midwifery reveals the dynamic relationship between this welfare state and the history of women and health. Midwives' individual stories, coupled with Susan L. Smith's astute analysis, demonstrate 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 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.