Mama's Got a Plan:

Maternity Care, Health Insurance, and Reproductive Justice

VBAC Roulette – AwakenMichigan

We continue to share cartoons created for other organizations. This post on Vaginal Birth After Cesarean was created in 2016 for AwakenMichigan: Reproductive and Sexual Justice Project





Handling it


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Miscarriage, although frequent, is little talked about. When it is, there seems to be one mandatory script, the one in which any fetal loss is treated as that of a born child. While this feeling is as valid as any other, we all experience pregnancy loss differently. This cartoon shows another viewpoint.

Image Credits

Unless otherwise noted, all images are shared under a Creative Commons license.

Pushed and Consented


Photo by chuttersnap on Unsplash

Product announcement!

We are very pleased to announce that our 20-page booklet, Pushed and Consented: Rights in Childbirth?, is available for purchase on the Birth Rights Bar Association website. Click the cover image to go straight there!

Cartoons with explanatory text address the question mark in the title and lay out the current legal landscape. Buy your copy today!

maternal barrier

If you would rather view the booklet online, it is available at this link. BRBA suggests making a donation if you choose view the booklet online.

Catching up cartoons

The following cartoons were published on Facebook before they were posted here. Without further ado …

Subject-consent-object (SCO order!)


The usage “consent the patient” is one that horrified us when it first came to our attention. If any verb should be an active one, “consent” is the one.

Image credits

“Doctor Visit” is by mohamed mohamed mahmoud hassan, shared under a Creative Commons license. We added the facial features, which were chosen from assortments provided here and here. The framed picture is courtesy a collection of fantasy landscape cartoons.


Medicaid work requirement

The Michigan Legislature has decided to prioritize removing health care from expanded Medicaid recipients who are not working sufficient hours. They were able to do so because the federal government urged states to apply for waivers in order to allow exactly this kind of proposal.

Medicaid was not established in order to force people in need to abandon their families and work sub-subsistence-level service jobs; rather, its purpose is to provide health care for those who cannot afford to purchase it, even with the subsidies that the Affordable Care Act provides (so far!). When one of the Senators behind this bill claimed that “work improves health,” we were moved to create this cartoon.

For those who require a translation for the ironwork behind the Senator: Arbeit macht Gesundheit.

Michigan Governor Snyder has not yet signed the bill, which was enacted on June 7, 2018. We encourage him to veto this measure and instead throw his support behind federal proposals to institute Medicare for All.

Image credits

The Senator and his podium are from an image entitled “Presentation,” by Mani Amini.  The audience is from a FEMA photo, in the public domain.



So many non-apologies arrive in the passive tense, don’t they? Another cartoon in the Bureau of Apologies series.

This image only suggests the offensive words issued by the doctor representing the American Birth Doctors Association (ABDO). The real-life context in which a major professional organization suggested that women control rising maternal mortality rates by using condoms (!) is described here.

Image credits

The doctor and his podium are both from

The HHS Office for Civil Rights

Personal beliefs and denial of care

Earlier this month, it emerged that tennis star Serena Williams came close to experiencing life-threatening blood clots after giving birth last fall, in part because medical staff delayed taking action after she requested treatment.

More recently, President Trump announced the establishment of a Conscience and Religious Freedom Division in the HHS Office for Civil Rights. Its purpose is to expand the ability of health care providers to exercise conscience clauses. ACOG, the chief U.S. professional organization for obstetricians and gynecologists, promptly issued a press release objecting to the move, stating, “Abortion, contraception and sterilization are a part of comprehensive reproductive health care and are essential to the health of patients. Professional medical organizations have clear guidance on the issue of refusal, noting that refusals of care must not compromise patient health.”

Well. All these announcements in such close proximity generated some questions in Ye Olde Cartoon Shoppe. Who is refusing care? To whom? What is their religious justification? Is it religion, or merely culture? What about having children, as opposed to not having them – are there any civil rights in play there?

Sometimes you look around, and no one is behaving the way you think they should. Except, of course, Ms. Williams, who acted intelligently and forcefully under challenging circumstances. And Baby Olympia, who does not need to do anything except be herself – which she so clearly does, perfectly and adorably. Congratulations on both counts, Serena Williams!  For all the other participants in these various dramas, there’s this:


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Images and permissions

  • The white-coated doctor is from Pixabay, shared under a Creative Commons license.
  • The plant is from The site does not state any terms of use, but seems to make images freely available.
  • The photo of Serena Williams and Beautiful Baby Olympia is taken from an online video. Ms. Williams did not to our knowledge speak the exact words attributed to her in this cartoon, but we believe we have correctly represented her intentions.
  • The distinguished fellow with the stethoscope comes from Michelangelo’s The Creation of Adam, where he appeared with more background and without the stethoscope. The work is in the Public Domain.

The Fellowship and US-MERA

A midquel is a “work that is set within the timeframe of a previous work, rather than before or after it.” The Fellowship of the Bill series featured an increasingly beleaguered and bedraggled band of legislative advocates journeying toward Michigan licensure for Certified Professional Midwives. In this midquel, the Fellowship encounters a Mysterious Elixir: newly emerging educational standards for midwives, as produced by a consortium of seven national midwifery groups, known collectively as US-MERA (U.S. Midwifery, Education, Regulation, Association). Three disclaimers are necessary before we proceed.

  • First: Whether certain educational standards should be included in CPM licensure legislation is inside baseball at its most extreme. We promise we will return to topics of more general interest in our next cartoon.
  • Second: Although Michigan’s experience with US-MERA was less than ideal, much of the chaos was a result of interweaving timelines. The education standards were being developed at exactly the same time that Michigan’s bill was proceeding through the legislature. Neither process was exactly predictable, nor did communication flow dependably between parties. Last-minute demands, confusions of meaning, and repeated shifts in focus made measured, documented decision-making quite a challenge.
  • Third: This cartoon arises solely from the fevered imagination of Mama’s Got a Plan. It is not to be taken as a statement of history or policy by anyone who matters.

As in our original Fellowship series, many liberties were taken with both Tolkien’s story and Michigan legislative history. No worries – just sit back and enjoy the ride.

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

The Fellowship of the Bill – Part 9

This is the final installment in the story of Michigan’s nine-year journey toward a law to license Certified Professional Midwives. The story begins HERE. The entire series can be accessed HERE.

Part 9


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About this panel

The Senate floor and House concurrence votes would have been a more striking triumph if more of the Fellowship had been awake for them (Frame 1). Eowyn’s thought bubble is an oblique tribute to this famous Far Side cartoon.

Michigan’s Governor Snyder is represented here as Galadriel (Frame 2) just to give someone the opportunity to repeat the character’s famous speech:

The Quest stands upon the edge of a knife. Stray but a little, and it will fail, to the ruin of all. Yet hope remains while the Company is true.

Sing it, Sister! Also, “Governor Galadriel” has a nice ring to it. The time span between the passage of the bill and the Governor’s signature seemed endless (Frame 3). The Yule feast pictured in Frame 4 is not only an outright  invention, but casually borrowed from a tour of New Zealand Lord of the Rings filming locations. In return, we suggest you check out tours at and make a point of stopping at the Green Dragon Inn near the Hobbiton Movie Set.

The Governor finally signed the bill early in 2017, a cause for great celebration (Frame 4). If you know anything about Michigan, you’ll appreciate the celebration did not take place shortly following the signing, but much later in the year on another equally beautiful – and much warmer – Lake Michigan beach.

Is this successful enactment of the bill the end of the Fellowship? Probably not. A portion of its membership is ensconced on the new state Board of Licensed Midwifery – portrayed here by a photo of a 1949 committee of the Florida State Prison system. A future effort to guarantee Medicaid coverage for Licensed Midwife care has also not been ruled out. For the meantime, the Fellowship is returned to its daily routines. Babies are born. Parents are created. Midwives are credentialed. Life goes on.

The End

P.S. A more detailed look at the Fellowship’s experience with US-MERA is available at I Have An Elixir to Sell You.


← Part 8

Michigan’s 9-part CPM licensure odyssey: part 8

The Fellowship of the Bill – Part 8

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 8


Click the image to open a larger version in a new window.

About this panel

While Michigan was toiling towards Mordor, other states continued to enact CPM licensure measures (Frame 1). The big surprise of 2013 was Indiana, a highly punitive state whose midwives had long been forced underground. Rhode Island regularized its midwives’ legal status in 2014, followed by Maryland in 2015. In 2016, Maine became the 30th state to license CPMs. The licensure acts just listed were evaluated by the Fellowship with mixed results, but the chief worry was that Michigan would be the very last state to pass such a measure.

Like the many-limbed Shelob, numerous entities and factors continued to threaten the Michigan bill (Frame 2). The medical lobby was joined in its opposition by the primary Michigan maternal and child health organization. Each Senate committee member had to be laboriously courted. Both majority and minority parties displayed their foibles, and the Fellowship hardly dared to shake its piggy bank. But the primary foe was time. Fellowship members regularly heard nightmare voices proclaiming the death of the bill.

After some heavy-duty compromising, the Fellowship was pleased to see its hard work pay off. When the bill passed out of Senate committee, it nevertheless felt like a miracle (Frame 3). Boromir, not being a midwife herself, developed a belief in the persuasive power of the “Midwife Voice.” At any rate, that’s how she explained the vote – and her own surprised willingness to take on tasks following Fellowship meetings.

It was late 2016. The legislative session was anticipated to end at an unnamed December date. Would the bill receive a Senate floor vote? Texts once again flew back and forth (Frame 4) between Fellowship members, Gandalf, Senate staffers, and anyone whose opinion might carry weight with Senate leadership. A failure would mean beginning all over again the following session, a prospect that filled the Fellowship – and its empty pockets – with dread.

← Part 7 • Part 9 →

Michigan’s 9-part CPM licensure odyssey: part 7

The Fellowship of the Bill – Part 7

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 7


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About this panel

Many others assisted the Coalition. The Big Push (see Page 1) was particularly helpful with both collective wisdom from other states and specific strategy and legal knowledge from Susan Jenkins, Big Push steering committee member and legal advisor (Frame 1). Likewise, Ida Darragh of NARM (North American Registry of Midwives) seemed to hold every licensed state’s education and training requirements in her head (Frame 2). Other direct entry midwives were generous with their advice and questions (Frame 3).

On the other hand, certain factions promised to oppose the bill no matter what, including a notorious national troll who had for years attacked midwives, home birth, physiological birth – anything that deviated from the standard medical model of care (Frames 4 and 5). Like many Jekyll-and-Hyde pontificators – or, in this case, Sméagol-and-Gollum ones – this troll typically appears with a wish to protect the safety of mothers and babies that quickly metamorphoses into vicious diatribes against midwives.

The ultimate wild card, however, was a local health care provider who opposed the CPM bill on the principle that licensure constituted government interference. She herself, of course, was licensed by the state (Frame 6). She is represented here as a hairdresser, to spare her real profession from embarrassment. The pile of Petoskey Stones behind her is included as Michigan Content.

← Part 6 • Part 8 →

Michigan’s 9-part CPM licensure odyssey: part 6

The Fellowship of the Bill – Part 6

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 6


Click the image to open a larger version in a new window.

About this panel

A whole new game began in 2016, as the bill’s success in the House piqued the interest of opposition groups, who then prepared to crush it (Frame 1). Their messages were nothing new – worries about vicarious liability for midwife practice, even though such a circumstance was already precluded by common law; and loud concerns for the safety of mothers and babies acting as a proxy for turf wars. The Fellowship sharpened its spears for the Senate campaign.

Meanwhile, however, any hope of accomplishing anything in either chamber was crowded out by the Courser-Gamrat scandal (Frame 2). Two Tea Party House members – married, but unfortunately not to each other – were discovered in a sexual relationship. That alone might not have kindled such a furore, but as per usual in the political arena, it was the failed cover-up that doomed the two lovebirds. Moral of the story: If your moral politics are those of an extreme conservative Christian legislator, any attempts to conceal your illicit affair by instructing your staff to leak a story that you are involved with a gay sex worker (!) are probably unwise. The feeding frenzy that followed culminated in the lovebirds’ ousters after a great deal of legislative process, which unfortunately occupied the Fellowship’s bill sponsor, who had the ill fortune to chair the Ethics Committee.

The Fellowship and its minions continued to dog legislators’ steps (Frame 3). As midwives, Fellowship members enjoyed endless connections to more or less everyone, and were not afraid to exploit those relationships. However, the real advances were made by engaging legislative staffers, who enjoyed – or at least shouldered – the responsibility to brief their bosses on pending legislation (Frame 4). Staffers typically had more time to devote to detailed analysis of issues and, furthermore, turned out to be instrumental in shaping legislators’ opinions. Indeed, some staffers helped the Fellowship by anticipating and managing the actions of other legislators (Frame 5). “Goatleaf” here is a composite of several extraordinarily effective staffers, who helped the bill progress despite numerous eleventh hour interventions that could easily have torpedoed it.

← Part 5 • Part 7 →