What each profession's own governing body requires before a person may attend a birth independently. Read as scope, never as ranking.
What each profession's own governing body requires before a person may attend a birth independently. Every figure is a floor, not typical practice, and the floors measure different things: a residency minimum counts procedures, a midwifery minimum counts a course of care.
Read this as scope, never as ranking. Nothing in this table says one clinician is better than another. It says what each was trained for, which is the only thing a transfer framework needs to know.
Last updated 30 September 2026.
5 sections.
| Credential | Births required | Also required | Source |
|---|---|---|---|
| Emergency physician | 10 vaginal deliveries, up to 3 of them simulated | 7 neonatal assessments at delivery, up to 2 simulated. No prenatal, postpartum or continuity requirement | ACGME EM Defined Key Index Procedure Minimums, effective 1 July 2028 |
| Family physician, standard residency | 20 vaginal deliveries | Competence in an uncomplicated spontaneous vaginal delivery and basic skills in managing obstetrical emergencies | ACGME FM Program Requirements 2026, 4.11.i.1.b (Core) |
| Family physician, maternity-care option | 80 deliveries, performed or directly supervised | 400 hours, or four months, dedicated to labor and delivery. Program must have FM faculty teaching prenatal, intrapartum, delivery and postpartum care | ACGME FM 2026, 4.11.i.2 (Core) and 2.7.d.2 |
| Certified Professional Midwife | 55 births: 10 as observer (2 planned hospital), 20 as assistant under supervision, 20 as primary under supervision (5 with full continuity) | 75 prenatal exams (20 initial), 20 newborn exams, 40 postpartum exams. Clinical training at least 2 years; apprenticeship typically 3 to 5 | NARM Candidate Information Bulletin, June 2025 |
| Family Medicine Obstetrics, certified | 60 vaginal deliveries, 15 of them in the last 2 years | ALSO and NRP, or equivalent | ABPS Family Medicine Obstetrics eligibility |
| Family Medicine Obstetrics, Surgical Qualification | The above, plus 70 cesareans as primary surgeon, at least 10 in the past 2 years | A 12-month full-time fellowship completed within the last 5 years. Alternative route: at least 5 years of ongoing clinical obstetric practice | ABPS Family Medicine Obstetrics eligibility |
| Obstetrician-gynecologist | 200 spontaneous vaginal deliveries | 145 cesareans, 15 operative vaginal deliveries. Four-year residency | ACGME OBGYN case log minimums |
| Certified Nurse-Midwife / Certified Midwife | No fixed national birth count | ACME sets competency-based rather than numeric requirements. Graduate degree, AMCB examination, recertification every 5 years | ACME; ACNM Core Competencies 2025 |
Family physicians are described as the rural backbone of American maternity care. They are the reason a county without an obstetrician can still have a birth attended by a physician. So it matters what the training actually requires, and there are four distinct rungs, not one.
### Rung 1. Standard residency: 20 deliveries
Every family medicine resident must have experience with a minimum of 20 vaginal deliveries and must demonstrate competence in performing an uncomplicated spontaneous vaginal delivery and basic skills in managing obstetrical emergencies.
That is the floor for every family physician in the United States.
### Rung 2. The maternity-care option: 80 deliveries and four months
A resident who intends to carry pregnancy care into independent practice, including intrapartum care and deliveries, must complete at least 400 hours or four months dedicated to labor and delivery and perform or directly supervise at least 80 deliveries.
Note the word in the requirement: option. The heavier training is elective, and it belongs to residents who choose it. ACGME also requires that a program offering it have family medicine faculty actually teaching prenatal, intrapartum, delivery and postpartum care, which not every program has.
### Rung 3. Family Medicine Obstetrics certification: 60 deliveries
Board certification in Family Medicine Obstetrics requires 60 vaginal deliveries, 15 of them within the last two years, plus Advanced Life Support in Obstetrics and Neonatal Resuscitation Provider, or equivalent.
### Rung 4. Surgical Qualification: 70 cesareans as primary surgeon
The surgical credential requires everything above plus 70 cesarean deliveries as primary surgeon, at least 10 of them in the past two years, and a 12-month full-time fellowship completed within the last five years. There is an alternative route for physicians with at least five years of ongoing clinical obstetric practice.
This is the family physician who can perform the cesarean in a rural hospital that has no obstetrician.
Obstetrics is elective in family medicine, at both ends.
The American Board of Family Medicine's 2026 core competencies list "Management of normal vaginal deliveries and related procedures" and "Caesarian section" not in the required core, but in the list of additional procedures that programs are "encouraged to provide... based on community needs, program mission, and available resources."
So the profession that is supposed to backstop maternity care in counties without obstetricians treats obstetric training as something a program may offer if it can. A family physician may finish residency having attended twenty births and never be required to attend another.
The distance between rung 1 and rung 4 is very large. Twenty deliveries to seventy cesareans as primary surgeon, with a twelve-month fellowship in between. "FM-OB" in conversation can mean any of four different things, and a midwife arranging a transfer to a rural hospital cannot tell which one is on call tonight.
That is a transfer-safety problem, not a criticism. It is the same problem the framework identifies with the word "midwife," which in Pennsylvania now covers four different preparations. One word, several trainings, and the person on the other end of the phone cannot tell which.
And the ordering is not what most people assume. A Certified Professional Midwife's 55 births sit above the standard family medicine residency minimum of 20 and above the emergency medicine minimum of 10, and her requirement additionally counts 75 prenatal, 20 newborn and 40 postpartum exams, which none of the physician minimums count at all. The physician minimums count procedures. The midwifery minimum counts a course of care.
Neither way of counting is wrong. They measure different things, which is exactly why they should not be read against each other as a ranking.
It does not use these numbers to argue that anyone should or should not be licensed, or that any clinician should or should not attend births.
It uses them for one purpose: the receiving end of a transfer needs to know what is actually on the other end of the phone, and a credential name alone does not say. That is why the framework asks for a named contact, a stated credential, and a call before transport.
- ACGME Program Requirements for Graduate Medical Education in Family Medicine, 2026: 4.11.i.1.b (20 vaginal deliveries, Core), 4.11.i.2 (400 hours and 80 deliveries, Core), 2.7.d.2 (faculty requirement). VERIFIED, read at source 30 September 2026. - American Board of Family Medicine, 2026 Core Competencies and Procedures: obstetric procedures listed among additional, encouraged procedures rather than the required core. VERIFIED, read at source 30 September 2026. - American Board of Physician Specialties, Family Medicine Obstetrics eligibility: 60 vaginal deliveries with 15 in the last 2 years; Surgical Qualification 70 cesareans as primary surgeon with 10 in the past 2 years, 12-month fellowship within 5 years, or 5 years ongoing practice; ALSO and NRP. VERIFIED. - ACGME Emergency Medicine Defined Key Index Procedure Minimums, effective 1 July 2028. - ACGME Obstetrics and Gynecology case log minimums. - NARM Candidate Information Bulletin, June 2025. - ACME and ACNM Core Competencies for Basic Midwifery Practice, 2025.
One caution. ABPS is not the only route to a family medicine obstetrics credential, and fellowship programs set their own volumes, many of them higher than the certification floor. Do not present the ABPS numbers as what every FM-OB fellowship requires. They are the certification floor.
Every figure is a floor, not typical practice, and the floors measure different things: a residency minimum counts procedures, a midwifery minimum counts a course of care. Nothing here says one clinician is better than another. It says what each was trained for, which is the only thing a transfer framework needs to know.