Axie Muldoon, the headstrong daughter of Irish immigrants, forced to beg for pennies as a child on the brutal streets on New York City, grows up to become the most successful – and controversial – midwife of her time.

'Saved' from poverty by a well-meaning philanthropist, Axie is sent West with her younger brother and sister. But the kindness of strangers is short-lived and soon Axie returns to the city of her birth, alone, but determined to one day reunite her family.

When she is taken in by a Manhattan doctor Axie learns the craft that she will live by – and later fight for. She rises from the gutter to the glitter of Fifth Avenue high society, and discovers that the right way is not always the way of the church or the law, and that you should never trust a man who says 'trust me.' But what if that man is an irresistible risk-taker with a poetical Irish soul?

As Axie's reputation grows she finds herself on a collision course with the crusading official who would be the righteous instrument of her downfall. It will take all of her power to outwit him and save both herself and those she loves from ruin.