This monograph investigates the development of what Tina Phillips Johnson terms the modern, or biomedical, birth model in Republican China up to the time of the second Sino-Japanese War in 1937. She also briefly presents the continuity of that model in the People's Republic of China. It provides information about the medical and technical changes in childbirth practices during that time. Johnson examines how the formerly private processes of childbirth increasingly become a public and national matter in the 20th century and discusses two aspects of this shift in particular: the increasing state regulation of birth and the development of professionalized midwifery.

One of the book's claims is that midwifery developed in China in ways dissimilar to the West. Whereas elsewhere births attended by midwives were phased out in favour of those attended by mostly male physicians, women trained in midwifery remained the primary birth helpers through to the post-Maoist era, and had a role in shaping those changes. “Unlike Britain and the United States, women in China, as mothers and as midwives, remained central to the redefinition and reconstruction of childbirth” (p. 65). Through a discussion of mostly missionary sources, including medical journals, we learn that modern, biomedical births were a Western import started during the late Qing dynasty by missionaries and Western-trained Chinese who advocated more hygienic birth models. Johnson asserts that reformers considered this a “modern” rather than “Western” method. Details from medical journals are used to show what went wrong with births attended by untrained and unhygienic midwives, and to show that reformers wanted clean, aseptic births and greater post-natal care. Chinese models and Western models diverged as those reformers, along with doctors and public health advocates, primary among them Western-trained Yang Chongrui (Marian Yang), professionalized midwifery to solve the problems of infant and mother mortality. A new profession of zhuchanshi (educated birth helpers) emerged in opposition to the traditional jieshengpo (“old women who receives the birth”) (p. 85). Johnson carefully explains that professionalized midwifery included training (often led by Yang's First National Midwifery School), licensing, regulation, standardization and the development of group identity.

Johnson presents her material thematically, perhaps to emphasize the point that the development of modern childbirth meant that the state (Kuomintang) made increasing incursions into what was formerly a private, family issue of childbirth. The book suffers from that approach. For one, it is repetitive. For example, we learn about the National Midwifery Board and its relationship to the First National Midwifery School in two chapters, 50 pages apart. But more significantly, without a chronological narrative it is left to the reader to unwind historical contingency and to untangle the reasons for change. Consider the professionalization of midwifery, one of the book's main themes. Johnson suggests many reasons why midwifery was professionalized, including that it “grew out of a shortage of western-trained physicians” (p. 74). She also touches on the significance of other factors, such as trends of hygienic modernity, an increase in the numbers of educated women, the insistence on modern medicine among urban elites, the influence of Western medical foundations and missionary organizations such as the Rockefeller Foundation and Peking Union Medical College, and the broader growth of public health initiatives. There is some good information here about these different organizations and trends, but not enough is done to weigh the merits of each in the development of the profession of midwives and its relation to the modern birth model.

Through the detailed discussions of the growth of institutions, lists of hospitals, and descriptions of traditional or modern medical births, I remained unconvinced that women (as midwives and mothers) were central to the processes of changing the definitions and constructions of childbirth as Johnson hoped to show. Discussions of pre-natal, parturient or new mothers' own conceptions of pregnancy or birth are mostly absent. There is some effort to uncover popular ideas of motherhood and pregnancy using advertisements and diagrams of reproductive systems found in contemporary periodicals. Detailed information about the growing number of births in urban hospitals shows that there was an increasing preference among the middle class for modern birth. Specific examples might have been drawn from articles in women's and family journals which would have shown how popular ideas about childbirth and mothering did change and what women thought about, or even learned about, motherhood and childbirth. Johnson provides some insight into how midwives understood the significance of their chosen profession in the development of a modern nation from plays found in midwifery school yearbooks (pp. 109–110). She also explains that some jieshengpo resisted modern training. This work could have been a more effective piece of women's history had Johnson made more of mothers' roles in changes in childbirth and made a more careful study of how midwives themselves, beyond their advocate Yang Chongrui, shaped definitions and constructions of new birth policies.