Mama's Got a Plan:

Maternity Care, Health Insurance, and Reproductive Justice

Unregulate me?

This post was conceived with the help of The Big Push for Midwives, which also helped out with its delivery.

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



Private Membership Associations

Earlier this year, news articles reported on criminal actions against community (out-of-hospital) midwives in Indiana and Nebraska following infant deaths. More recently, the work of one midwife in Minnesota was highlighted; she was not under state investigation, nor were any bad birth outcomes mentioned. 

What do these three midwives have in common? They all have formed Private Membership Associations (PMAs), legal instruments that claim to exempt their members from state regulation. Clients of these midwives become members of PMAs, which supposedly allow them to essentially contract out of state governance of their midwives. 

However, in reality it doesn’t work that way. States with licensing regimes, like Indiana, allow their state midwifery boards to issue complaints against negligent midwives, whether the midwives have obtained licenses or not. Because the unlicensed practice of a profession is a criminal offense, these complaints are often conveyed to the state attorney general’s office, after which charges may be filed against the midwife. In states that do not offer licensing of community midwives, like Nebraska, the route to criminal charges is much more direct: reports of a bad outcome may land immediately on the county prosecutor’s desk.

The cartoon above is our take on why PMAs are a bad idea, and why midwife licensing is a good idea. Many people these days mistrust government – and who can blame them? But remember: the answer to bad law isn’t no law; the answer to bad law is good law.

An aside about PMAs, birth outcomes, and midwife arrests

When midwives are arrested after a newborn or maternal demise, as in the news articles linked above, some readers find it tempting to channel their lock-em-up-and-throw-away-the-key rage right at them. Allow us to take this opportunity to remark that physicians rarely face arrest when their patients die. Furthermore, this post is in no way a comment about the outcomes in any of the births in the news articles or on the level of skill and training possessed by the midwives who attended those births. Midwives are often blamed for bad birth outcomes no matter what their license status, training, skill, or education. The shamefully high infant and maternal mortality rates associated with conventional hospital-based care, on the other hand, is just starting to be questioned.

Image credits

All images are shared under a Creative Commons license, unless otherwise noted. Where required by license, changes to the image are noted.

Panel 1: 

Panel 2: 

  • The Fortress Midwifery building is really part of the
    Golubac Fortress in the Đerdap national park in Serbia.
    The image is from Max Pixel and is in the public domain.
  • The Viking longboat is by Midnightblueowl. We added the torch by Kiernax.
  • The bomber is by U.S. Air Force. The image is in the public domain.
  • The helicopter is by Capt. Richard Barker. The image is in the public domain.
  • The sailing ship is a photograph of Cannon Fired by Willem van de Velde the Younger, 1707. The photo is by the Rijksmuseum, Amsterdam and is in the public domain.
  • The Virginia-class attack submarine is by Owly K. The photo is in the public domain.
  • The cannon is from a photo of the Saint Kitts – Brimstone Hill Fortress, taken by Martin Falbisoner.

Panel 3

  • The background is a photo of the Ballroom at Rideau Hall, Ottawa, by Dennis Jarvis. We cropped the image, edited out some chairs along the back wall, and swapped the portrait of Her Majesty Queen Elizabeth II with one of Martha Ballard, midwife. 
  • The lectern is from “WikiData Presentation 2018,” by Michelle Nitto
  • The pink house in the poster is of Zemīte Manor, by J. Sedols.
  • The projector screen is from Max Pixel.
  • The midwife/breastfeeding mother is by Renoir. She is wearing an oxytocin necklace. Her bag is from It is filled with a water bottle by wraithrune, a yoga mat by MikesPhotos, and a sweet little stuffed cow by OpenClipart-Vectors.
  • The Big Push for Midwives logo is from The Big Push for Midwives! You should check them out!
  • Finally, the speaker at the lectern is Cynthia Jackson, CPM, LM, of Michigan: midwife extraordinaire and unparalleled portrait subject. The photo is used with permission. Ms. Jackson runs Sacred Rose Birthing Service and is a founder of the Mosaic Midwifery Collective, both in Detroit. 

Graphic and Fact Sheet: U.S. Midwives – Now You See ‘Em, Now You Don’t – AwakenMichigan

We continue to share cartoons created for other organizations. This one, on the history of midwives in the U.S., was created for AwakenMichigan: Reproductive and Sexual Justice Project

Rather than composing a new fact sheet to accompany this graphic, we instead include a paper (see below) written in 2012 for the edification of the students in our Reproductive Justice class offered at the University of Michigan for several years through the Women’s Studies Department. First, however, a few explanatory notes on the graphic:

Page 1

Page 2

Page 3

Page 4

  • Frame 1. The Practicing Midwife is a journal found in the University of Michigan Libraries’ collection. Many of those images were used in the 2013 conference exhibit, Birthing Reproductive Justice: 150 Years of Images and Ideas. You can still view the online portion of the exhibit. In the middle photo, Geradine Simkins is shown holding her recent book, Into These Hands: Wisdom From Midwives (2011). Simkins is included here because she is a key figure in the revival of Michigan midwifery. Finally, no discussion of a women’s health issue would be complete without a copy of Our Bodies, Ourselves, most recently reissued in 2011.
  • Frame 3 is very complex and difficult to read – by design. For information on Certified Professional Midwife licensure, we refer you to The Big Push for Midwives. The ladies marching in the old photo are, alas, not really midwives, but members of the International Ladies’ Garment Workers, taking part in the Shirtwaist Makers Strike of 1909. Consider that to be artistic license on our part.
  • Frame 4 situates midwifery care inside the larger struggle for Reproductive Justice. We highlight the work of Tewa Women UnitedBlack Women Birthing Justice,  Strong Families, and every person who has stood up for Black Lives Matters. These individuals and organizations are all worthy of your support. Finally, the plant pictured is the Rose of Jericho, pointed out by Bellies and Babies as being particularly helpful to women in labor.

We are grateful to Marinah Farrell, LM, CPM, of Arizona, and President of the Midwives Alliance of North America, for her very helpful critique and suggestions. Thanks for midwifing our graphic, Marinah!


Source: Graphic and Fact Sheet: U.S. Midwives – Now You See ‘Em, Now You Don’t – AwakenMichigan

On Mama’s bookshelf


Our bookshelf overfloweth! Here is a sampling of the reproduction-related volumes that have crossed our desk in the last few months.

a-midwifes-storyA Midwife’s Story (1986), by Penny Armstrong and Sheryl Feldman, relates how Armstrong, a nurse-midwife, comes to live near the Amish in Lancaster County, PA and provide care to them. It’s a very tender description of the families she comes to serve and love, as well as the change she herself undergoes in the process.


After Birth (2015), by Elisa Albert. Ari and Paul move to upstate New York from the city when she is six months pregnant. The book begins as Ari is just emerging from her first year postpartum after a traumatic birth. In a town of poverty-stricken fading grandeur (of a kind we’re all too familiar with here in the Rust Belt), Ari’s friendship with a newly-arrived poet/musician is the mirror in which she views her own recovery progress. The first person narrative showcases Ari’s powerful and intensely personal voice:

Adrienne Rich had it right. No one gives a crap about motherhood unless they can profit off it. Women are expendable and the work of childbearing, done fully, done consciously is all-consuming. So who’s gonna write about it if everyone doing it is lost forever within it? You want adventures, you want poetry and art, you want to salon it up over at Gertrude and Alice’s, you’d best leave the messy all-consuming baby stuff to someone else.


Terrible Virtue (2016), by Ellen Feldman, is a fictionalized biography of Margaret Sanger. It describes her humble origins, her relationships with her husband and her children, and – always – the Cause.

sex-is-a-funny-wordSex is a Funny Word: A Book About Bodies, Feelings, and You (2015), by Cory Silverberg and Fiona Smyth. This children’s book identifies the requisite body parts and touches very briefly on babymaking, but chiefly addresses feelings and relationships. It’s probably best suited to children ages 8-14, but readers outside that range will still find gold nuggets between the covers.

Its hallmark is the beautiful diversity of bodies. The challenge of displaying different skin tones is resolved by including skin colors from real life and technicolor faces. The faces shown display a variety of features; these people look like your friends – if you can imagine your friends with blue, green, and purple faces!

The book examines any number of emotionally complicated topics quite sensitively and sensibly. This is the book you wish you’d had when you started asking questions no one would answer.

Interestingly enough, the narrative voice that is progressive and inclusive enough to recognize the work of midwives and avoid giving health care providers sole credit for “delivering” the baby nevertheless fails to question a practice that is the epitome of doctor-patient power relationships:

When a baby is born, the doctor or midwife who helped it be born looks at its new naked body.
If they look down and see a penis, they say, “It’s a boy.”
If they look down and see a vulva, they say, “It’s a girl.”

Why is it necessary for a provider to pronounce the sex of the child? Under the midwife model of care, parents are empowered to make that discovery themselves. On reflection, the ultimate power of mainstream maternity care is that it provides parents with the sex of their child while it is still in utero. This realization, however, is more a critique of that power relationship than of this book.

Our library copy of this book included – charmingly – two to-do lists. One was clearly wedding-related (“gym/tanning” and “drop off wedding dress”). The other listed tasks connected with a camping trip. Perhaps the happy couple was planning for children on their honeymoon?

bottomlandBottomland (2016), by Michelle Hoover, follows a German-American family of Iowa farmers at the end of the first world war. One night, two of the family’s daughters disappear from the house. What can have happened to them? Their older brother seeks them in Chicago while the remaining family deals with the hostility of their community that thirsts for answers about the death of a generation of sons in the war. Beautifully written, and takes advantage of the historical context of the story.


How it was possible for us to miss one of our favorite author’s books from way back in 2013, we don’t know. Life After Life, by Kate Atkinson, explores the life of Ursala Todd, born in England in 1910, by means of a multiple chapters titled “Be Ye Men of Valor,” Snow,” “War,” “Armistice,” “Peace,” and “A Lovely Day Tomorrow,” among others. In some pattern that is difficult to discern, these chapters draw out a common event that leads to different endings, in the context of the era spanning two world wars. The point, of course, is the twin roles of chance and choice in our lives.  This is a book that should be read multiple times, in order to tease out the intricacies of Atkinson’s plot(s)!


Sara Donati is another favorite author, for her Wilderness series, “six historical novels that follow the fortunes of a group of families living in upstate New York from about 1792-1825.” Her faithful readers rejoiced when Donati announced a new series, beginning with The Gilded Hour (2015), set in 1883 New York. Historical figures grace the pages of this novel, most notably Anthony Comstock, of the Comstock Laws that prohibited distribution of contraceptives, making The Gilded Hour a fine book to read alongside Terrible Virtue (see above). Like the Wilderness series, this newest novel portrays the work life and love life of one woman, within the context of her historical surroundings and fictional community. Readers can expect details on Dress Reform, midwifery and medicine, America’s melting pot/salad bowl, and the rights and restrictions women experience in making families for themselves.

the-long-way-homeWe experienced Louise Penny’s The Long Way Home (2014) by way of audiobook, as read by the late Ralph Cosham. Her tenth novel featuring the Québécois sleuth, Inspector Armand Gamache, it concerns the disappearance from the village of Three Pines one half of an artist couple, Peter Morrow. Peter’s wife Clara journeys with Gamache into the far reaches of Canada to search for Peter. This novel features a quest, a mystery that turns on the artist’s identity, and, as usual, brie on every sandwich.


Happy reading to all! Remember to support your public library by borrowing often to boost circulation figures. Michigan residents with participating libraries should remember the Michigan ELibrary is able to quickly place interlibrary loans and put many top-grade collections within our reach.


Bookshelf graphic is in the public domain, from