The overall picture of changing birthing practices is complex and sometimes tinged with ironies. As the introduction says, "These Samoan nurses and midwives did not immediately attempt to mediate new and old ways of birthing after the colonial leadership of their profession left. They themselves became cultural agents for change as they continued the role of 'colonizing' their own birth tradition and taught the fa'atosaga [Samoan for midwife] Western techniques, at the same time trying to provide a professional midwife for all women. Paradoxically they often chose a social midwife for their own births and supported or at least condoned the social midwives close to them. . . . Kaisarina, while working as the leading professional midwife in the country, and working almost totally in hospital practice herself, simultaneously assisted her mother-in-law with her social practice of midwifery. Vipulo's story shows how a professional midwife preferred to have her mother, a social midwife, deliver her at home."

A particular objective of the authors is to encourage a reconception of maternity care in countries where professional services are rare and not available to all women. The book challenges common assumptions, still held in many postcolonial countries, that a simple migration of Western-style, hospital-focused care is necessarily always an achievable or desirable goal. It also demonstrates the considerable progress that one group has made in rethinking and developing a model of maternity care that works within their society and culture. As these midwives' stories suggest, solutions to some of the problems caused by gaps in the kinds of resources that Westerners take for granted can be found in partnerships and cultural wisdom that already exist in Samoa and, by extension, other developing countries.

Recent anthropological scholarship on “new midwifery” centers on how professional midwives in various countries are helping women reconnect with “nature,” teaching them to trust in their bodies, respecting women’s “choices,” and fighting for women’s right to birth as naturally as possible. In No Alternative, Rosalynn A. Vega uses ethnographic accounts of natural birth practices in Mexico to complicate these narratives about new midwifery and illuminate larger questions of female empowerment, citizenship, and the commodification of indigenous culture, by showing how alternative birth actually reinscribes traditional racial and gender hierarchies.

Vega contrasts the vastly different birthing experiences of upper-class and indigenous Mexican women. Upper-class women often travel to birthing centers to be delivered by professional midwives whose methods are adopted from and represented as indigenous culture, while indigenous women from those same cultures are often forced by lack of resources to use government hospitals regardless of their preferred birthing method. Vega demonstrates that women’s empowerment, having a “choice,” is a privilege of those capable of paying for private medical services—albeit a dubious privilege, as it puts the burden of correctly producing future members of society on women’s shoulders. Vega’s research thus also reveals the limits of citizenship in a neoliberal world, as indigeneity becomes an object of consumption within a transnational racialized economy.