Although until the late 1960s women’s reproductive health care had been largely the domain of Palestinian women healers, midwives, and nurse-midwives, the contemporary reproductive healthcare system in Palestine is medicalized, masculinized, and commodified in an indigenous society already suffering from the brutality of Israeli occupation. Based on interviews with eight experienced Palestinian midwives, scholarly and field research, and field knowledge, this article examines ideological and practice differences among midwives, and between some nurse-midwives and traditional midwives (dayat), largely in contemporary Jerusalem and the West Bank. It highlights sharp gendered class contradictions in midwives’ relations to obstetrician-gynecologists and the Palestinian Authority Ministry of Health; points to the rise and impact of a biomedical interventionist risk sensibility on the physician-led hospital shop floor; and considers the psychic and sexual dimensions of working with women seeking reproductive healthcare, including the impact of trauma and limited reproductive agency.