Mama's Got a Plan:

Maternity Care, Health Insurance, and Reproductive Justice


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.

 

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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

C

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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!

 

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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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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 →


Obamacare, Again

 

Image Credits


The Promised Land

40-years-in-the-wilderness-p1 40-years-in-the-wilderness-p2

Forty Years in the Wilderness

Forty years is a long time to seek a home. With Passover approaching and U.S. politics running wild, it’s tempting to view the biblical journey through the desert as a metaphor for current-day immigration policy – or global warming, or the nature of leadership. However, your cartoonist feels that a woman’s 40-year fertile capacity (more or less) lends itself nicely to a comparison with the journey to the Holy Land. So – let the menstruation train leave the station!

This is your life!

our-bodies-ourselvesIn the late 1970s, girls were less well informed on matters of reproductive health. Some of us were lucky enough to have mothers who gave us copies of Our Bodies, Ourselves, the classic women’s health book. It contained an menstrual-diagraminformative diagram of reproductive anatomy, with some helpful words about menstruation:

Starting to menstruate will always be different for each person – welcome to some, just the beginning of inconvenience for others.

Liberal mothers also gave their daughters copies of Judy Blume’s books; Are You There God? It’s Me, Margaret was the Platonic ideal of menstrual fiction.

fast-times-at-ridgemont-highNevertheless, the predominant source of information for pre-internet and pre-video-era girls searching for more relevant information than we received in our sixth-grade Kotex-sponsored filmstrips was, of course, movies and TV. In Carrie, Sissy Spacek’s wonderful and terrifying performance of menarche-triggered telekinesis did not convince us of our ability to cause knives to fly across the room (more’s the pity), but it did present some – wholly incorrect – estimations about the amount of blood involved in a menstrual cycle. Fast Times at Ridgemont High wasn’t specifically about menstruation, but it was about adolescent awakening. We couldn’t resist the photo of Phoebe Cates and Jennifer Jason Leigh discussing sex while slicing a sausage.

The 1972 episode of Norman Lear’s Maude, in which the title character considers – and obtains – an abortion, was a first in TV history. Yet to girls five years later, the shock was that Maude could get pregnant at all. Did people that old still have sex? Even in our surprise, however, we never considered what this might mean for our menstrual selves. Had we understood the implications – and had Costco existed at that point – we might have stocked up on truckloads of feminine hygiene products.

In that context, menopause does seem a lot like the Promised Land.

The Red Stuff

The Passover story is full of blood. We’ve taken certain liberties with the text, but the raw material, if you’ll excuse the phrase, was already there. The first of the Ten Plagues turned the waters of the Nile into blood. The final plague slew the first-born sons of all those who had not painted their doors with blood from the Passover sacrifice. This was hardly menstrual blood (although think of the lambs they might have saved!) – but still, as far as symbols go, blood is blood.

midol_combinedReturning to a more personal history, we repurposed this 1950s advertisement for Midol into a shape116px-rembrandt_-_moses_with_the_ten_commandments_-_google_art_project suggestive of the stone tablets Moses is about to smash in the background.
The bat mitzvah girl shown is perhaps less than thrilled with her new-found womanhood; she seems to be reading the phrase from Exodus 7:17, “and it will turn to blood,” with something of an attitude.

Her attitude might well derive from the difficulties girls faced – at least in the time and circumstances this cartoon presents – in adapting their lives to a menstrual cycle.

But in the end, what is our cultural aversion to blood all about? What makes blood so scary, or at least so significant? One might argue that most people who aren’t surgeons or phlebotomists are unaccustomed to encountering blood outside the body, and that we therefore find something transgressive in its appearance. But wait! Who sees blood every month! And what does it mean?

119px-holman_miriam_and_the_israelites_rejoicingMiriam rejoices after the Israelites have crossed the Red Sea. (We know it’s really the Reed Sea, but humor us, please.) Perhaps she is celebrating more than a narrow escape: that is, her own superiority as a woman to the men who perished. They can only fight and die, but she can create new people. How like a deity! In fact, her exclamation is ambiguous: is she apostrophizing the Giver of Life or does she consider herself the giver of life? Of course, all of this is your cartoonist’s invention, as Exodus does not feature Miriam celebrating her capacity for procreation.

A traditional morning blessing said by Jewish men thanks the Almighty for not creating them as
gabriel-cornelius-von-maxwomen. Could it be they protest too much? This prayerful man is having second thoughts, remembering the mother and child of his youth. When we penned the words “Uterus Envy,” we had no idea that this concept existed outside our cartoon. It turns out that neo-Freudian psychiatrist Karen Horney (1885–1952) got there first, creating the concept of Womb Envy.
What does Womb Envy mean to a woman who has had 40 years of a hard-working uterus? Not much. The Promised Land may represent the delights of fertility unachievable by Moses, while simultaneously symbolizing freedom from fertility to women who have been there and done that.

Image Credits

The title frame features the painting, Moses leading the Israelites out of Egypt, by József Molnár, 1861. This work is in the public domain.

Frame 5: Moses Viewing the Promised Land, by Frederic Edwin Church, 1846. This work is in the public domain.

Frame 7: The Story of Passover by Marking the Israelites Door Coloring Page is shared under a Creative Commons license.

Frame 8: Moses Smashing the Tablets of the Law, by Rembradt, 1659. This work is in the public domain. The photo, A Conservative bat mitzvah in Israel, is shared here under a Creative Commons license.

Frame 10: Miriam and the Israelites Rejoicing, an illustration from the Holman Bible, 1890. This work is in the public domain.

Frame 11: A Jewish Man in His Prayer Shawl, by Lesser Ury, 1931. This work is in the public domain.
Motherly Love, by Gabriel Cornelius Ritter von Max (1840-1915). This work is in the public domain.

Frame 12: Moses Views the Promised Land, an engraving by Gerard Jollain from the 1670 La Saincte Bible. This work is in the public domain.