Mama's Got a Plan:

Maternity Care, Health Insurance, and Reproductive Justice

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.

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





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


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

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


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

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 →

Michigan’s 9-part CPM licensure odyssey: part 5

The Fellowship of the Bill – Part 5

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 5


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

About this panel

The continual contacts required to maintain support in the Legislature turned the Fellowship and the larger birth community into merciless Polyannas (Frame 1). A certain amount of weariness was occasionally discernible in staffers’ greetings upon their discovery that the voice on the other end of the phone was yet another plea to support the midwife bill.

The long journey began to tell upon the Fellowship (Frame 2). Most of its members were practicing midwives, in itself a hard occupation to reconcile with family life. Responding to frequent sudden requests to appear in Lansing, formally dressed and well-spoken, made for a heavy burden, especially as progress appeared stalled, thanks to Rep. Sarumon’s refusal to schedule a committee hearing (see Part 2). However, Michigan term limits do occasionally work to the advantage of those doing Noble Work, and a double strategy ensured the bill’s safe crossing (Frame 3) to a committee hearing: First, Rep. Sarumon was termed out of the House. Poof! Second, the bill sponsor wisely arranged for it to be assigned to a different committee in the new session.

The bill promptly received two hearings, at which ACOG proclaimed that the legislation did not conform to the (as-yet-undefined) US-MERA standards. Nevertheless, in November 2015, the bill passed out of committee (Frame 4). The Fellowship’s satisfaction with this success was nothing compared to the jubilation after the bill’s 79-25 (bipartisan!) vote on the House floor. Lobbyist Jean proclaimed that such a day did not come often in the life of a public affairs consultant, which explains her declared intention to commemorate the event with a tattoo on a Body Part to be Named Later (Frame 5).

Any success effected by sustained exertion should be followed by celebration and repose. Unfortunately, those pleasurable activities are inevitably followed by mass thank-you note writing (Frame 6).

← Part 4 • Part 6 →


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


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

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


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

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


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

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


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

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 →