Mama's Got a Plan:

Maternity Care, Health Insurance, and Reproductive Justice

Michigan’s 9-part CPM licensure odyssey: part 4

The Fellowship of the Bill – Part 4

This is the continuing story of Michigan’s nine-year journey toward a law to license Certified Professional Midwives. The first installment of the story is HERE.

Part 4


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About this panel

Frame 1 illustrates the complete lack of directional sense displayed by a few Fellowship members and highlights some finer points of Michigan geography. It also bestows a nod on the traditional Michigan-Ohio rivalry. No, not college football, but the early 19th century war for possession of the Toledo Strip.

Both the 2011-12 and 2013-14 legislative sessions featured a committee chair known to the Fellowship as “Rep. Bottleneck” (Frame 2). Married to a physician (although not a pediatrician), Rep. Sarumon prevented the bill from progressing in the House.

When the bill finally did progress in the 2015-16 session, it ran smack into the development of a new national standard for midwifery practice, US-MERA (US Midwifery Education, Regulation, Association) (Frame 3). Beset with communication and timing snafus of the most vexatious kind, US-MERA seemed like the all-seeing Eye of Sauron, threatening the success of the bill at every step. Consumers working for licensure felt particularly disgruntled, having had no representation at the US-MERA deliberations.

What felt like the final nails in the bill’s coffin in 2014 were reactions to a highly publicized bad outcome at a birth center situated just outside the state capital. Although local supporters valiantly stood behind the birth center, in the end a number of midwives’ careers were ended and the center closed. Furthermore, the state senator who represented the center’s district (Frame 4) sponsored a misguided, poorly-constructed bill that attempted to create brand-new law for all midwives in the state – including nurse-midwives, who were already licensed as nurses. Up against the nurses’ political might and as a member of the minority party, the senator could not have expected the bill to succeed. However, its introduction created sufficient Sturm und Drang to severely inconvenience the Fellowship. In addition, midwife antagonists summoned national trolls (see Page 7), whose attention to Michigan midwife issues generated further fire and brimstone.

The Fellowship was always willing to meet with opposition groups (Frame 5). Troppo is Lansing’s premier restaurant frequented by politicos. During one such dinner, your cartoonist made the mistake of ordering the dish suggested by the Orc. It turned out to consist mostly of raw kale, garnished with sauerkraut. The combination of this roughage with the company did not increase its digestibility.

Much more toothsome were the baked goods distributed by the Fellowship during its annual Cookie Day (Frame 6). Butter, sugar, and adorable children are as effective as Lembas Bread in ensuring survival.


← Part 3 • Part 5 →



Michigan’s 9-part CPM licensure odyssey: part 3

The Fellowship of the Bill – Part 3

This is the continuing story of Michigan’s nine-year journey toward a law to license Certified Professional Midwives. The first installment of the story is HERE.

Part 3


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About this panel

The chronology of the Fellowship is worthy of a document of its own (Frame 1). Originally a committee of the Michigan Midwives Association, it gradually moved to admit a consumer member from the Friends of Michigan Midwives. In order to present a unified front in Lansing, the group eventually changed its name to the Coalition to License CPMs: Families & Professionals for Safe Home Birth.

After the bill sponsor was identified and the bill introduced, the Fellowship began the never-ending task of meeting with legislators in order to educate them on the issue of out-of-hospital midwifery in Michigan (Frames 4-8). The questions posed in these frames are ones that the Fellowship was often asked. Are you wondering whether the characters shown represent specific Michigan legislators? Perhaps. More interesting, though, are the Michigan-specific items in each frame:

  • Frame 5. The little brown jug – although here it is blue.
  • Frame 6. Ted Nugent concert poster.
  • Frame 7. Vase of Black-Eyed Susans.
  • Frame 8. Mounted deer head. The Coalition remarked that a legislator’s party affiliation could be inferred from the presence or absence of mounted animal parts.

The background for each of these frames is a bona fide space in Michigan’s Anderson House Office Building, in which the Fellowship passed many productive hours.


← Part 2 • Part 4 →


Michigan’s 9-part CPM licensure odyssey: part 2

The Fellowship of the Bill – Part 2

This is the continuing story of Michigan’s nine-year journey toward a law to license Certified Professional Midwives. The first installment of the story is HERE.

Part 2


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About this panel

Back in Michigan – or, if you will, Lothlórien – the midwives began the work of convincing their colleagues, including one who had been arrested in the 1980s for the unauthorized practice of medicine (Frame 2). Other midwives were also beginning to feel uneasy, suspecting they were under scrutiny by law enforcement. A senior midwife (Bilbo Baggins – see Page 3) had a personal connection to Jean Doss, a wizard of a lobbyist experienced in licensure initiatives (Frame 3). However, that very experience made her reluctant to launch herself into another licensure fight. She warned the midwives that such legislation took at least 20 years to enact. Nevertheless, her determination and savvy were key ingredients in the quest.

It was all very well to speak of legislation, but a bill required a sponsor (Frame 4). The tall order faced by the midwives and their lobbyist was to identify a legislator of the majority party (Republican), who was not near to being termed out, who had some knowledge and sympathy for midwifery care, and who was not indebted to any medical professional groups. The group wooed and won freshman representative Ed McBroom, a dairy farmer from Michigan’s rural and remote Upper Peninsula. Not only had a midwife attended the home births of his (then) three children, but he himself had also been born at home. As were his cows (Frame 5).

And what were Michigan families – the “consumers” – up to during this time? Around the year 2000 Pamela Pilch, a Michigan mother, lawyer, opera singer, and all-around good egg, founded the Friends of Michigan Midwives, an organization intended to provide services to busy midwives. Although Pam left the state several years after, FoMM was later revitalized in order to support the licensure effort. For whatever reason, FoMM attracted many volunteers named Melissa: Melissa Hale and Melissa Ryba are both past presidents. Melissa Furlette, now a CNM, also served on the board. The hive metaphor was chosen because “Melissa” means “bee” in Greek, as does “Deborah” in Hebrew, as remarked by Deborah Fisch, another FoMM board member. The current president of FoMM is Elizabeth Hawver, whose name was left out of this frame because it unfortunately does not fit in with the bee naming scheme. Sorry, Beth! In every other way, you are the perfect leader!


← Part 1Part 3 →


Michigan’s 9-part CPM licensure odyssey: part 1

The Fellowship of the Bill

Series introduction

Michigan’s nine-year journey toward a law to license Certified Professional Midwives was nothing less than a heroic quest. How better to portray it than through the story of The Lord of the Rings? The first book in Tolkien’s trilogy, The Fellowship of the Ring, seemed an appropriate choice to describe the hopes and strivings of the merry band of sisters that – slowly, excruciatingly – pushed legislation from opposition to enactment. Material in this cartoon was taken from Tolkien’s books and Peter Jackson’s films.

Many liberties were taken with both Tolkien’s story and Michigan legislative history. Events portrayed did not necessarily occur exactly as shown. Objects in mirror are closer than they appear. Onwards!

Part 1


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About this panel

The immediate inspiration for this cartoon was a tableau created by Cardboard Box Office. That worthy website is the brainchild of a family that recreates scenes from famous movies using only the materials already present in their home, with cardboard boxes playing a large role. Their Facebook link to “The Lord of the Teething Ring” was subtitled “One does not simply crawl into Mordor.” It refers, of course, to the warning given by Boromir in one of the early scenes of the movie:

One does not simply walk into Mordor. Its black gates are guarded by more than just orcs. There is evil there that does not sleep. The great eye is ever watchful. It is a barren wasteland, riddled with fire, ash, and dust. The very air you breathe is a poisonous fume. Not with ten thousand men could you do this. It is folly.

In our cartoon, Mordor is represented by Lansing; make of this comparison what you will. The capitol building is shown in Frame 2 foregrounded against a very angry-looking Mount Doom. The Michigan Legislature badge pinned to the building is worn by every legislator in this cartoon. Watch for it!

Drives to Lansing, while not perhaps as heroic as journeys on horse or on foot with staff and backpack, were nevertheless fraught with the unforeseen (Frame 3). A great number of the Fellowship were midwives and parents; illness, childcare problems, women in labor, last-minute texts, and typical midwife-style driving featured frequently.

Midwives are not usually called to births by eagles (Frame 4), but fantasy permits us this fiction. Fantasy extended to the legal position of Michigan midwives pre-licensure. Some opponents of licensure believed the practice of home birth midwifery to be legal on the basis of Michigan v. Hildy, a 1939 judicial decision itself based on a much earlier Attorney General’s opinion. Supporters of licensure, however, pointed out that the enactment of the 1978 Public Health Code superseded the old decision because of its overhaul of health care professional licensure. In addition, even should a midwife succeed in fighting off a criminal conviction by citing Hildy, a licensure act in and of itself would alert the judiciary and prosecutors alike that out-of-hospital midwifery was regulated, and therefore not a crime.

Several Michigan midwives who doubted the need for licensure attended a 2007 Chicago summit offered by The Big Push for Midwives, a national advocacy group formed to support and coordinate state CPM licensure efforts (Frame 5). The midwives underwent a conversion experience, driven in part by warnings of plans underway by the American Medical Association to further restrict midwifery scope of practice with its “Scope of Practice Partnership” initiative. The Big Push urged states to initiate licensure legislation in order to forestall the AMA’s plans, which were cleverly portrayed by Pushers as “SoPPzilla” (Frame 6, and see next page). Strider, a.k.a. Aragorn, is revealed here to be Katie Hemple, a member of The Big Push Steering Committee.

Part 2 →