Midwife, Direct Entry Licensing

States Licensed


of 50 states and D.C.


Burden Rank


for average burdens 1st is worst


Combined Rank


for states licensed x average burdens 1st is worst

Change from 2017 to 2022, if any:
Burden increased
Burden decreased
Mixed burden change
New license
Eliminated license
2022 Licensing Burden Rank
Lower Burden Rank
Higher Burden Rank
No state license
Prohibited without a higher-level license

How does my state compare to others?

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Direct-entry midwives, or lay midwives, are non-nurses who provide prenatal care and childbirth assistance. They generally work in homes, birthing centers and other non-hospital settings. See Appendix B for details.

2022 Snapshot

  • 14 unlicensed states; 7 states prohibit without a higher level license
  • Days lost range from 730 (24 states) to 2,330 (Indiana)
  • Fees range from $822 (New York) to $5,600 (Alaska)
  • 37 states require 1+ exam
  • 17 states set minimum age
  • 34 states set minimum grade

Changes Since 2017

  • 7 licenses created by Alabama, the District of Columbia, Hawaii, Illinois, Kentucky, Maine and Oklahoma; none removed
  • Fees changed in every state except New York and Alaska and nearly always increased; 21 states reduced education, while Texas raised it
  • Burden rank improved 3 spots, largely because of large net education reductions; combined rank worsened 10 spots, largely because of 7 new licenses

2022 Licensing Burden in Detail

N New License
E Eliminated License

Data Notes: 2022 data collected between February 3, 2020, and March 18, 2022. Fees include charges for application review and license issuance; exams; background checks, credit reports and fingerprinting; recovery fund contributions; third-party certification; and certain fees for training courses. Calendar days lost were estimated based on required education and experience; except for amounts smaller than one day, days lost are rounded to whole days and thus may not reflect very small changes between 2017 and 2022. Appendix A details methods for estimating days lost and calculating burden ranks. Complete data, including revised 2017 data, are available at https://ij.org/report/license-to-work-3/ltw3-data/.

Additional Resources