SAWA BEPPU LIVED very differently from most immigrant women in early-twentieth-century Seattle. She had one of the few telephones in her neighborhood and was one of the first women in the city to drive a car. Her husband Hisuji gave music lessons and worked for a while in a department store, but mostly he stayed home and, with their five children, did the chores. That was hardly a common role for issei (Japanese immigrant) husbands, but Hisuji doesn’t seem to have minded; it freed Sawa to be the main breadwinner. So demanding was her occupation that when her son Lincoln married, she gave consent only on condition that he live at home so his wife Teru could also help with housework.

That occupation was midwifery, and it brought status and independence as well as remuneration. At a time when immigrant farmworkers made $1 a day, midwives could earn $25 per birth. When Sawa landed in 1905, midwifery degree in hand from Tokyo Imperial University, she joined a vibrant network of issei practitioners. Their training, modeled on Germany’s, was well-regarded here, and as Susan L. Smith recounts in Japanese American Midwives, they dominated the field on the West Coast. Sawa delivered more than 1,000 babies, as many as 10 a month, white, African American, Filipino, and Chinese as well as Japanese. Many of her clients lived in remote farm communities; small wonder she needed a car.

Midwives typically gave more personalized care than doctors. Sawa saw her clients weekly before delivery and visited daily for several weeks afterward. She did not practice surgery or use forceps, but she may have used a fetascope (to listen to unborn hearts) and herbs such as ergot, which midwives worldwide have employed for centuries to stop hemorrhaging. She knew when to call in a doctor but also how to handle difficult births such as twins and breech babies—skills few doctors employ in this age of ready C-sections. She and her colleagues met monthly to swap notes and pass around a midwife journal from Japan.

Despite her modern training, Sawa upheld the traditional belief that women earned honor by bearing birth pains (called jintsu, “battle pain”) in silence. Her pregnant daughter-in-law Teru took this example too much to heart. Smith recounts that Sawa came home one day to find Teru determinedly fixing dinner even with advanced contractions. She had Teru lie down and rigged a sheet around the bedstead that she could tug for leverage.

Despite a shortage of medical workers, no midwife was allowed to work at any of the 10 internment camps.

While Sawa Beppu prospered in Seattle, a campaign against midwives was building elsewhere. Medical journals promoted legislation in various states to make what one called “the ignorant meddlesome midwife a thing of the past”—even though studies in the 1910s and ’20s found that maternal death rates were lowest where the percentage of midwife-attended births was highest. By 1930 the practice of midwifery was nearly eliminated from most of the country.

Out West, officials were more accepting of midwives. That may have been because the rest of the country was oversupplied with physicians who competed with midwives for clients, but the West had a doctor shortage. Its few midwives served mainly immigrants and so did not threaten the mainstream doctors. And so many western states passed midwife licensing laws; Washington, California, and Colorado passed theirs in 1917. Washington’s implicitly favored immigrants: It required that each licensee graduate from a midwifery school with at least 14 months’ training, something not available in this country. Sawa Beppu received the first license.

As immigrants grew acculturated and came to rely on doctors, the local midwifery trade declined. It ended with the 1942 Japanese-American internment. Sawa performed her last deliveries under wartime blackouts and Japanese curfews. She and Seattle’s other Japanese midwives were then sent to the Minidoka Relocation Center in southern Idaho, where the home-birth tradition abruptly ceased. The barracks had no bathrooms or running water, and women were ordered to deliver their babies at the camp hospital. Japanese doctors and nurses were pressed into service, but, despite a shortage of medical caregivers, not a single midwife was allowed to work at any of the 10 western internment camps.

After the war, the interned midwives did not resume the practice, and no new midwives took it up in Washington. Then, in the 1970s, the feminist health movement revived interest in midwifery. That interest has grown as studies have found that it offers an alternative at least as safe as hospital delivery for low-risk births, at a third of the cost. Because Washington had been spared the antimidwife campaign, its 1917 licensing law remained on the books. In 1975 a Danish woman and a Chilean woman received the first licenses in decades. In 1978 the Seattle Midwifery School started, finally providing the required training in-state. Today, Washington mothers opt for home birth at twice the national rate. If she were here, Sawa Beppu would be proud, though she might have more competition.