My Notorious Life by Kate Manning

Axie Muldoon begins her story as one of the thousands of poor Irish immigrant children sent west on an orphan train.  But the pull to return to her Mam and the plan to reunite her family is too strong so she and the renegade Charlie head back to the slums of NYC.  She is eventually taken in by a "Dr." Evans and his wife, who practices in the "area of female care." What she learns under their tutelage will one day make her Madame DeBeausacq - one of the wealthiest - and most dangerous - women in the city.  She not only becomes adept at delivering babies but also at making sure that there is an alternative to an unwanted pregnancy.  The story spans from the 1860's to the beginning of the 20th century and is loosely based on the life of Ann Trow Lohman who originally earned the title of "most notorious woman in NYC".  Both came under the hammer of the Comstock laws enacted in the late 19th century.  The chance to explore the role of women in this time make this a compelling read.  And the ending is great.