In recent years there has been a growing trend for physician groups to develop guidelines to establish levels of hospital care based on health care team expertise and physical resources. A growing number of fetal centers have been established as the field of fetal medicine continues to evolve. In 2015, the state of Texas began an initiative to develop guidelines for the certification of fetal centers. After significant input from clinicians, a series of rules was developed by the Department of Health and Human Services. Site visits for certification are expected to begin in the near future. Specific leadership, personnel, and facility requirements were developed. Maternal as well as fetal and neonatal outcomes were mandated to be transparent to the public through websites. A commitment to ongoing research and the education of future fetal interventionists was included. Lessons learned from this process should be considered when a national fetal center certification process is developed. Although the Texas legislation defined only a single level of fetal center, a multi-tier designation system, much like that used to define levels of neonatal and maternity care, would be a more acceptable approach. A level I center would offer diagnostic and needle-based procedures, and a level III center would offer all evidence-based fetal procedures. Because the field of fetal medicine and intervention continues to advance rapidly, a national certification process for fetal centers should be considered.