It might sound the same but it isn't. For example, in Oregon, it's optional to be licensed as a direct-entry midwife. Meaning, you can get licensed and follow a scope of practice and get certain prescriptive privileges along with Medicaid reimbursement... or not and get none of that. Either way, you're still legally practicing. In CA there is regulation of direct-entry midwives so if you're practicing midwifery but don't have a license, you're illegal. In IL, direct-entry midwives are flat out illegal. In MI there is no regulation so you're neither practicing legally or illegally. And as you can see, without a legal definition, the consumers and midwives don't have much to fall back on, especially when things go terribly wrong.