Pushing in Silence came out at a complicated time. With an estimated three thousand deaths from Hurricane María and a highly publicized fight about how to fund Medicaid in Puerto Rico, how do we read a book about how modernization drove women on the island to give birth in hospitals—except as tragedy? It’s possible that the answer is, in part, that it is more important than ever to restore a sense of the island as a complex place with a rich history—as much more than a disaster. This book certainly gives us that.